Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-26T14:09:20.429Z Has data issue: false hasContentIssue false
  • English
  • Français

Patient cues and medical interviewing in general practice: examples of the application of sequential analysis

Published online by Cambridge University Press:  11 October 2011

Christa Zimmermann ,
Lidia Del Piccolo  and
Maria Angela Mazzi
Christa Zimmermann*
Affiliation:
Department of Medicine and Public Health, Service of Medical Psychology, University of Verona, Verona, Italy
Lidia Del Piccolo
Affiliation:
Department of Medicine and Public Health, Service of Medical Psychology, University of Verona, Verona, Italy
Maria Angela Mazzi
Affiliation:
Department of Medicine and Public Health, Service of Medical Psychology, University of Verona, Verona, Italy
*
Address for correspondence: Professor Ch. Zimmermann, Department of Medicine and Public Health, Section of Psychiatry, Service of Medical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona (Italy). Fax: +39-045-585871 E-mail: christa.zimraermann@univr.it
Get access Rights & Permissions [Opens in a new window]

Summary

Aims – To illustrate how sequence analysis may be applied to the medical interview to: 1. explore how physicians without formal training in communication skills elicit and respond to patient cues and expression of expectations and opinions; and 2. test the hypothesis that physicians' closed ended questions determine the use of subsequent closed ended questions. Methods – 238 consultations in primary care, coded with the Verona Medical Interview Classification System, were analysed. Lag 1 analysis was applied to study which physician behaviour precedes and follows patient cues. Pattern recognition analysis for five lag sequences was performed to test the occurrence of predefined specific code chains, where a closed and an open ended question were followed either by two closed-ended questions or by two patient facilitating interventions Results – Patients' cue offers were most likely after facilitative interventions, but not after open-ended questions; physicians were most likely to respond to these expressions with facilitation. Physicians' tendency to use closed ended questions increased after previous closed questions and decreased after an open-ended question. Conclusions – Lag sequential analysis and pattern recognition analysis are useful methods to study exploratory and theory driven hypotheses and allow an initial approach to validate the supposed appropriateness of specific physician interventions.

Declaration of Interest: none.

Keywords

sequence analysismedical interviewVR-MICS.
Type
Sequence Analysis of Patient-Provider Interaction
Information
Epidemiology and Psychiatric Sciences , Volume 12 , Special Issue 2: Sequence Analysis of Patient-Provider Interaction , June 2003 , pp. 115 - 123
Copyright
Copyright © Cambridge University Press 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Agresti, A. 1996. An Introduction to Categorical Data Analysis. John Wiley & Sons Inc: New York.Google Scholar
Bakeman, R. & Quera, V. 1995. Log-linear approaches to lag-sequential analysis when consecutive codes may and cannot repeat. Psychological Bulletin 118, 272–284.CrossRefGoogle Scholar
Brown, J.B., Stewart, M.A. & Tessier, S. 1995. Assessing Communication between Patients and Doctors, a Manual for Scoring Patient-centred Communication. CSFM Working Papers Series: Montreal.Google Scholar
Butow, P.N, Dunn, S.M, Tattersall, M.H. & Jones, Q.J. 1995. Computerbased interaction analysis of the cancer consultation. British Journal of Cancer 71, 1115–1121.CrossRefGoogle ScholarPubMed
Cohen-Cole, S.A. 1991. Vie Medical Interview: the Viree-Function Approach. Mosby-Year Book: St. Louis.Google Scholar
Davenport, S., Goldberg, D. & Millar, T. 1987. How psychiatric disorders are missed during medical consultations. Lancet 22, 439–441.CrossRefGoogle Scholar
Del Piccolo, L., Benpensanti, M.G., Bonini, P., Cellerino, P., Saltini, A. & Zimmermann, C. 1999. [The Verona Medical Interview Classification System/Patient (VR- MICS/P): the tool and its reliability]. Epidemiologia e Psichiatria Sociale 8, 56–67.CrossRefGoogle ScholarPubMed
Del Piccolo, L., Saltini, A., Zimmermann, C. & Dunn, G. 2000. Differences in verbal behaviours of patients with and without emotional distress during primary care consultations. Psychological Medicine 30, 629–643.CrossRefGoogle ScholarPubMed
Del Piccolo, L., Mazzi, M.A., Saltini, A. & Zimmermann, C. 2002. Inter and intra individual variations in physicians' verbal behaviour during primary care consultations. Social Science and Medicine 55, 1871–1885.CrossRefGoogle ScholarPubMed
Del Piccolo, L., Putnam, S.M., Mazzi, M.A. & Zimmermann, C. (in press). The biopsychosocial domains and the functions of the medical interview in primary care: construct validity of the Verona Medical Interview Classification System. Patient Education and Counseling.Google Scholar
Ford, S., Hall, A., Ratcliffe, D. & Fallowfield, L. 2000. The Medical Interaction Process System (MIPS): an instrument for analysing interviews of oncologists and patients with cancer. Social Science and Medicine 50, 553–566.CrossRefGoogle ScholarPubMed
Gottman, J.M. & Roy, A.K. 1990. Sequential Analysis: a Guide for Behavioral Researchers. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Henbest, R.J. & Stewart, M.A. 1989. Patient-centredness in the consultation. 1: A method for measurement. Family Practice 6, 249–253.CrossRefGoogle ScholarPubMed
Marvel, M.K., Epstein, E.M., Flowers, K. & Beckman, H.B. 1999. Soliciting the patient's agenda: have we improved? Journal of American Medical Association 282, 283–287.CrossRefGoogle Scholar
Mathworks 1998 MATLAB Release 5.2. Mathworks: Natik, MA.Google Scholar
Mazzi, M.A., Del Piccolo, L. & Zimmermann, C. 2003. Event-based categorical sequential analyses of the medical interview: a review. Epidemiologia e Psichiatria Sociale 12, 81–85.CrossRefGoogle ScholarPubMed
Mead, N. & Bower, P. 2002. Patient-centred consultations and outcomes in primary care: a review of the literature. Patient Education and Counseling 48, 51–56.CrossRefGoogle ScholarPubMed
Roter, D.L. & Hall, J.A. 1987 Physician's interviewing style and medical information obtained from patients. Journal of General Internal Medicine 2, 325–329.CrossRefGoogle ScholarPubMed
Saltini, A., Cappellari, D., Cellerino, P., Del Piccolo, L. & Zimmermann, C. 1998. An instrument for evaluating the medical interview in general practice: VR-MICS/D (Verona-Medical Interview Classification System/Doctor). Epidemiologia e Psichiatria Sociale 7, 210–223.CrossRefGoogle ScholarPubMed
Silverman, J., Kurtz, S. & Draper, J. 1998. Teaching and Learning Communication Skills in Medicine. Radcliff Medical Press: Abingdon.Google Scholar
Smith, R.C. 1999. Comprehensive, research-based interviewing guidelines in general practice settings. Epidemiologia e Psichiatria Sociale 8, 85–91.CrossRefGoogle ScholarPubMed
STATA Corporation 1999. STATA Statistical Software: Release 6.0. College Station: STATA Corporation, TX.Google Scholar
Stewart, M.A. 1984. What is a successful doctor-patient interview? A study of interactions and outcomes. Social Science and Medicine 19, 167–175.CrossRefGoogle ScholarPubMed
Stewart, M.A., Brown, J.B., Donner, A., Me Whinney, I.R.Oates, J., Weston, W.W. & Jordan, J. 2000. The impact of patient centred care on outcomes. Journal of Family Practice 49, 796–804.Google Scholar
Stiles, W.B. 2002. Description versus evaluation of medical interviews. Epidemiologia e Psichiatria Sociale 4, 226–231.CrossRefGoogle Scholar
Suchman, A.L., Markakis, K., Beckman, H.B. & Frankel, R.A. 1997. A model of empathic communication in the medical interview. Journal of American Medical Association 277, 678–682.CrossRefGoogle Scholar
Tavaré, S. & Altham, P.M. 1983. Serial dependence of observations leading to concingency tables, and corrections to chi-squared statistics. Biometrika 70, 1139–144.CrossRefGoogle Scholar
Zimmermann, C. & Tansella, M. 1996. Psychosocial factors and physical illness in primary care. Promoting the biopsychosocial model in medical practice Journal of Psychosomatic Research 40, 351–358.CrossRefGoogle ScholarPubMed