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Open Access Highly Accessed Research article

Patients’ views on changes in doctor-patient communication between 1982 and 2001: a mixed-methods study

Ligaya Butalid1*, Peter F M Verhaak12, Hennie R Boeije3 and Jozien M Bensing14

Author Affiliations

1 NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN, Utrecht, The Netherlands

2 Department of General Practice, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands

3 Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands

4 Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands

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BMC Family Practice 2012, 13:80  doi:10.1186/1471-2296-13-80

Published: 8 August 2012

Abstract

Background

Doctor-patient communication has been influenced over time by factors such as the rise of evidence-based medicine and a growing emphasis on patient-centred care. Despite disputes in the literature on the tension between evidence-based medicine and patient-centered medicine, patients’ views on what constitutes high quality of doctor-patient communication are seldom an explicit topic for research. The aim of this study is to examine whether analogue patients (lay people judging videotaped consultations) perceive shifts in the quality of doctor-patient communication over a twenty-year period.

Methods

Analogue patients (N = 108) assessed 189 videotaped general practice consultations from two periods (1982–1984 and 2000–2001). They provided ratings on three dimensions (scale 1–10) and gave written feedback. With a mixed-methods research design, we examined these assessments quantitatively (in relation to observed communication coded with RIAS) and qualitatively.

Results

1) The quantitative analyses showed that biomedical communication and rapport building were positively associated with the quality assessments of videotaped consultations from the first period, but not from the second. Psychosocial communication and personal remarks were related to positive quality assessments of both periods; 2) the qualitative analyses showed that in both periods, participants provided the same balance between positive and negative comments. Listening, giving support, and showing respect were considered equally important in both periods. We identified shifts in the participants’ observations on how GPs explained things to the patient, the division of roles and responsibilities, and the emphasis on problem-focused communication (first period) versus solution-focused communication (last period).

Conclusion

Analogue patients recognize shifts in the quality of doctor-patient communication from two different periods, including a shift from problem-focused communication to solution-focused communication, and they value an egalitarian doctor-patient relationship. The two research methods were complementary; based on the quantitative analyses we found shifts in communication, which we confirmed and specified in our qualitative analyses.

Keywords:
Quality of care; Doctor-patient communication; Analogue patients; General practice; Video observation; Mixed-methods design