Patient-clinician Interaction Research Articles

Interobserver reliability of a "Standardized Psychiatric Examination" (SPE) for case ascertainment (DSM-III).

The authors describe the Standardized Psychiatric Examination (SPE), a new method for conducting psychiatric examinations in both clinical and research settings that preserves the clinical method. The SPE provides a consistent replicable format for eliciting and recording psychiatric history, signs, and symptoms without perturbing the patient-clinician interaction. By means of the SPE, the clinician can formulate diagnoses using DSM-III or ICD-9 criteria and yet generate CATEGO profiles derived from the Present State Examination, 9th edition. Psychiatrists using the SPE demonstrated high interrater reliability in ascertaining individual psychopathological symptoms (Kappa range, 0.55 to 1.0) and in making DSM-III diagnoses (Kappa range, 0.79 to 1.0) among a sample of study subjects (N = 43) drawn from both a psychiatric inpatient population and a large community sample of nonpatients from the Epidemiological Catchment Area (ECA) study. The implications of the SPE for clinical practice and for research are discussed.

Systematic analysis of clinician-patient interactions: a critique of recent approaches with suggestions for future research.

Clinician-patient interactions are an important, but poorly understood, feature of our personal health care system. Attributes of these interactions have been shown to affect the health care process and appear as well to be amenable to change, furnishing a rationale for their study. Communications theory provides useful guidelines for systematic analysis. Systems of interaction analysis should take account of information transfer occurring on different levels through a variety of behaviors, incorporate interaction context and sequence into categorization schemes, deal with the unique characteristics of clinical encounters, and lend themselves to clinical teaching. Application of these guidelines to three representative systems (Bales' Interaction Process Analysis, Stiles' Verbal Response Modes, and Katz's Resource Exchange Analysis) illustrates diverse strengths and weaknesses. Future research on clinician-patient interactions should include the development of new analysis systems, a broader research time frame, increased emphasis on antecedents of interactions, and implementation of controlled trials.

Medical compliance and the clinician-patient relationship: A review

A 4-category classification of research on elements of provider-patient interaction that appear related to compliance behavior is presented. The first category describes research on pedagogical techniques employed by practitioners to inform patients in detail of the patient behaviors prescribed to deal with the medical problem. This category contains studies of both correlational and experimental design that support the hypothesis that greater provider explicitness regarding needed patient behaviors is associated with better patient follow-through. The second category of research deals with studies that indicate an association between extensive clinician-patient sharing of expectations about appropriate behaviors in the dyad and good patient compliance. In this category, research has not yet proceeded beyond correlational and descriptive research designs to experimental design. The third category contains studies that reveal links between the patient's assumption of responsibility for his own therapy and compliance. In this division the supporting research is both correlational and experimental. The final category contains research linking positive and supportive tone of the clinician-patient interaction with good patient adherence. Research design in this category has not yet reached the experimental level of development. The concepts and results of research in each category are quite promising. Randomize trials of methods of intervention derived from each category seem called for, though favorable results in different settings, with different combinations of treatments are by no means yet assured.

Psychosocial aspects of craniofacial disfigurement: A “State of the Art” assessment conducted by the Craniofacial Anomalies Program Branch, The National Institute of Dental Research

The psychosocial sequelae of craniofacial disfigurement may have as great an impact on the patient as the strictly physical aspects of the problem. Very little systematic work has been focused directly on these effects. The following broad recommendations would constitute initial research steps in this field: Development of satisfactory measures of physical attractiveness and their use in studies to explore the role of craniofacial features in over-all physical attractiveness. The establishment of valid metrics for assessing the severity of craniofacial anomalies through the use of both physiologic and behavioral measures, thus constructing a broader definition of what constitutes a craniofacial handicap. Studies of the relationships among physiologic and behavioral variables using recently developed statistical techniques and computer methods to determine the psychosocial consequences of craniofacial disfigurement. Studies of the process through which persons with various types of malocclusion decide to seek and complete treatment. The studies would include the patients' demographic characteristics, self-perceptions, perceptions of them by others, and the complex patient-clinician interactions during the treatment programs.

Psychopharmacology: The Significance and Insignificance of Drugs: Two Paradigms

Conflict is expressed in the vast majority of clinician—patient interactions —over the definition of the problem, the goals of treatment, the methods of treatment, and conditions of treatment and the relationship itself — and negotiation by various strategies is essential to the resolution of the conflict.

Sampling of speech pathology treatment activities: an evaluation of momentary and interval sampling procedures.

Videotaped samples of aphasia treatment sessions were coded, using the Clinical Interaction Analysis System (CIAS), a 39-category system for recording the events that occur in clinician-patient interactions during aphasia treatment sessions. These coded records were then sampled according to various schedules and procedures and the fidelity with which each sampling schedule and procedure represented the content of the entire treatment record was evaluated. In addition, trained observers coded videotaped samples of treatment, using the CIAS with a number of sampling schedules and procedures. The fidelity with which these observers' records represented the content of the treatment sessions sampled was then evaluated. The results of the analysis indicated that momentary sampling at intervals distributed throughout the session generates more accurate records of session content than single longer samples taken from the session, unless those single samples comprise a major part of the session, and that sampling representativeness remains high even when only one event in ten is sampled, if sampled events are uniformly distributed throughout the session.

Interviewing and Patient Care.

The latest edition of this highly successful introduciton to medical interviewing has three new chapters--Emotional and Behavioral Responses to Illness and to Patients, Interviewing the Older Adult, and Interviewing and Continuing Care--as well as a new section on eliciting the sexual history. Focusing on the human side of the clinician-patient interaction, this concise, practical work will be of great value to medical, nursing, and allied health students. From reviews of the second edition: A superb book....It is aimed at medical students, for all of whom it should be required reading, but even a Fellow of the American College of Physicians could gain a great deal from its study.--Annals of Internal Medicine.