Assessing communication competence in the primary care medical interview

Abstract

The purpose of this paper is to present preliminary results of a language‐based coding system to analyze physician‐patient communication. This system is grounded in the framework of Cegala and Waldron's (1992) context‐based model of communication competence which reflects the sequential development of talk as primary to definitions of competence. Given a review of the model and identification of information exchange and relational development as the primary tasks in the medical interview, two research questions were advanced to test a coding scheme. Based on the notion that aligning one's utterances to meet self‐ and other‐goals relates to communication competence, the coding scheme was developed to include message content, function, and uptake. Frequency results showed that 32 physician‐patient dyads produced 10, 958 coded utterances. Physicians and patients contributed relatively equal numbers of units. The frequencies of each category and exploratory sequential patterns relating to competence are summarized along with a discussion of the limitations of the analytical system. Overall, the code system provided new information on content, uptake, and sequential patterns of information exchange previously unavailable from published coding scheme results. Yet, the present scheme needs to be refined to produce output that more readily identifies competent and less competent interactions. These results and issues are placed in the context of an ongoing, larger research program on communication competence in the primary care interview.