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Med Care. 1979 Jun;17(6):667-81.

Interaction exchange structure and patient satisfaction with medical interviews.


The verbal interaction between patients and physicians in 52 initial interviews in a university hospital screening clinic was studied using a new discourse coding system. Factor analysis of category frequencies showed that each interview segment, medical history, physical examination, and conclusion, consisted mainly of two or three types of verbal exchange. Patient satisfaction with the interviews, assessed with a questionnaire that yields separate scores for satisfaction with cognitive and affective aspects, was found to be associated with exchanges involving the transmission of information in particular interview segments. Affective satisfaction was associated with transmission of information from patient to physician in "exposition" exchanges during the medical history, in which patients told their story in their own words. Cognitive satisfaction was associated with transmission of information from physician to patient in "feedback" exchanges during the conclusion segment, in which physicians gave patients information about illness and treatment.


Analysis of the verbal interaction between physicians and patients in 52 initial interviews at a university hospital screening clinic found a strong association between patient satisfaction and the provision of information. Factor analysis identified 2 principal types of verbal exchange in the medical history (exposition and closed question), 2 in the physical examination (further data and physical examination) and 3 in the conclusion (final clarification, feedback, and patient termination). Affective satisfaction, defined as patients' perceptions of warmth and understanding from their doctor, was associated with exposition exchanges in the medical history--i.e., patients being permitted to tell their story in their own words. Cognitive satisfaction--the patient's feeling that they understand their illness and its treatment--was associated with feedback exchanges in the interview's conclusion, i.e., physicians' giving objective information. The positive relationship between patient satisfaction and certain verbal interactions that enhance the exchange of information has been noted in previous surveys of patient satisfaction. The taxonomy of verbal response modes use in this study is a sensitive, flexible system that makes clinically relevant distinctions beyond the scope of other coding systems. Its use should be considered for further research on the effects of medical encounters and for specifying effective interviewing skills.

[Indexed for MEDLINE]

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