Dimensions of patient and physician roles in medical screening interviews

Social theorists have agreed that physicians are usually presumptuous and controlling while patients are usually deferent and acquiescent in medical encounters, but have disagreed about patient reaction to these reciprocal roles. One view has been that the status and power gap is bridged by a pattern of patient trust and physician attentiveness, while another view has been that patients become alienated as physicians use their control to maintain their institutionalized authority. These views were tested in a sample of 52 medical screening interviews with adults using an utterance-by-utterance coding system that yields scores on three dimensions in interpersonal roles, attentiveness', acquiescence' and 'presumptuousness'. Coding yielded quantitative descriptions of patient-physician interaction that conformed closely to theoretical expectations. Patient satisfaction, assessed by a post-interview questionnaire, was positively correlated with physician acquiescence in the conclusion segment of the interview but not in the medical history or physical examination. Patients were also more satisfied when they expressed themselves in their own words during the medical history and when physicians were more informative in the conclusion segment. The results suggest possible refinements in current theoretical views of patient and physician roles.

Duke Scholars

Author Sherman A. James Sanford School of Public Policy