This document discusses doctor-patient communication and interactions. It provides an overview of some of the most cited authors on this topic, including DiMatteo, Hall, Kaplan, and Roter. It describes the Roter Interaction Analysis System (RIAS), a method for coding doctor-patient interactions. The document also lists some of the most cited journals on this subject and discusses lay information mediaries, models of mediary behavior, and methods used to study doctor-patient communication such as observational scales.

1. Examining Doctor- Patient Interactions and CommunicationDorothy Gallop, Ian Parsells, Mary Chu1

2. 2Some of the Most Cited Authors:DiMatteo, R. Hall, J.A. Kaplan, S.H., Greenfield, S. Levinson, W.Ong, L.M.L.Roter, D.L. The Roter Interaction Analysis System (RIAS) Stewart, M. Stiles, W.B., Putnam, S.M., Wolf M.H., James, S.A.Waitzkin, H.

3. 3The Roter Interaction Analysis System (RIAS) is a method of coding doctor-patient interaction during the medical visit. The system is broadly derived from the seminal work of Robert Bales for assessing patterns of small group interaction during problem-solving and decision-making (Interaction Process Analysis, Cambridge, Mass.: Addison-Wesley, 1950). The RIAS differs substantially from the original Bale's Process Analysis in four ways: • The coding approach is tailored to dyadic exchange specific to the medical encounter. All patient and physician dialogue is coded into categories that may be applied to each speaker, although some categories may be more common to a particular speaker. • Categories are tailored to directly reflect the content and context of the routine dialogue between patients and doctors during medical exchanges. • Identification and classification of verbal events are coded directly from videotapes or audiotapes and not transcripts. • Since coding is done directly from video or audiotapes, rather than transcripts, assessment of the tonal qualities of interaction is possible. These tonal qualities transmit the emotional context of the visit beyond the significance of the words spoken. Based on a general affective impression, coders rate both the patient and physician on global affective dimensions such as anger, anxiety, dominance, friendliness and interest. 55 page paper explaining the Roter methodhttp://www.rias.org/manual.pdf

4. 4Some of the most cited journals Annals of Family Medicine British Medical Journal Information Research Journal of the American Board of Family Practice Journal of the American Medical Association Journal of Health Communication Journal of Health Economics Journal of the Medical Library Association Patient Education and Counseling Social Science & Medicine Sociology of Health & Illness

5. 5So Many Choices, So Little Time…

6. 6 Lay Information MediariesParents Spouse Other Family Members

7. 7Figure 1: View 1 of the lay information mediarybehaviour Model

8. 8Figure 2: View 2 of the lay information mediarybehaviour Model

9. 9The rise of the e-patientSusannah Fox from the Pew Internet and American Life Project discusses the latest research on e-patients, including now many people are engaging in social media for health. Fox also gives advice for how patients can avoid information overload when going online.http://www.icyou.com/topics/politics-policy/health-2-0-meets-ix-susannah-fox

10. 10RCS-ORelational Communication Scale for Observational Measurement

11. 11Immediacy/affectionThe physician was intensely involved in the conversation with the patientThe physician did not want a deeper relationship with the patientThe physician was not attracted to the patientThe physician found the conversation stimulatingThe physician communicated coldness rather than warmthThe physician created a sense of distance between he/she and the patientThe physician acted as if he/she was boredThe physician was interested in talking to the patientThe physician showed enthusiasm while talking with the patientSimilarity/depthThe physician made the patient feel that they were similar to he/sheThe physician tried to move the conversation to a deeper levelThe physician acted like he/she and the patient were good friendsThe physician seemed to desire further communication with the patientThe physician seemed to care if the patient liked him/her or notReceptivity/trustThe physician was sincereThe physician was interested in talking with the patientThe physician wanted the patient to trust him/herThe physician was willing to listen to the patientThe physician was open to the patient’s ideasThe physician was honest in communicating with the patient

12. 12ComposureThe physician felt very tense talking with the patientThe physician was calm and posed with the patientThe physician felt very relaxed talking with the patientThe physician seemed nervousThe physician was comfortable interacting with the patientFormalityThe physician made the interaction very formalThe physician wanted the discussion to be casualThe physician wanted the discussion to be informalDominanceThe physician attempted to persuade the patientThe physician did not attempt to influence the patientThe physician tried to control the interactionThe physician tried to gain the approval of the patientThe physician did not try to win the patient’s favorThe physician had the upper hand in the conversation

13. 13Domains of communication in the provider-patient relationship

14. 14House demonstrates how to not engender trust…http://www.youtube.com/watch?v=pZsICYJ1tW4first minute and 8 seconds

15. 15

16. 16Why they thought the doctor had a negative feeling about the information,'The doctor brushed me off "because that is not what's wrong with you"'.

17. 'Because I was going against his advice he was difficult, but finally agreed'.

18. 'The doctor obviously felt that it was not the correct method of treating the problem'.

19. 'The doctor thought I was trying to self diagnose'.

20. 'He said he was the doctor... what did I know?'17What other communication behaviors transpire and what are patients looking for in their relationship with their doctors?

21. 18What are some of the methods used to study these communications?

22. 19“Towards a theoretical framework”L.M.L. Ong, et al(1995)

23. Nonverbal Behavior and CommunicationWhat do we say when we’re not talking? What’s hidden underneath when we are? Are words the only means of information transfer?20

24. Nonverbal Behavior and CommunicationWhen did we start discussing Nonverbal Behavior?What we recognize as Nonverbal Behavior began with Charles Darwin back in 1872. According to Darwin, earlier in our evolutionary history, Nonverbal Behaviors had specific functions that now have lost their initial meanings. Over time, these behaviors have gained a communicative value as they provide others with external evidence of someone’s internal state. (Krauss et al., 1996)21

25. Nonverbal Behavior and Communication What constitutes as Nonverbal Behavior and why is it important? According to D.L. Roter, J.A. Hall, et al. (2005), nonverbal behavior includes communicative behaviors that do not carry content of a linguistic nature such as: Facial Expressivity

26. Smiling/Frowning

27. Eye Contact

28. Head Nodding

29. Hand Gestures

30. Posture and Body Leaning

31. Position

32. Appearance

33. Speech Rate

34. Loudness

35. Pitch

36. Pauses

37. Interruptions

38. Tone“An estimated 60-65% of the meaning in a social encounter is communicated nonverbally,” (Griffith et al., 2003). 22

39. Nonverbal Behavior and CommunicationConfused?Then let’s begin with some visual examples!http://www.youtube.com/watch?v=cEkT5uspE3c23

40. Nonverbal Behavior and CommunicationHow does this apply to Physician-Patient interaction?Nonverbal communication often anticipates, alters, substitutes for, emphasizes, or even contradicts verbal communication and it’s the primary way people express emotions. (Griffith et al., 2003)

41. Emotion-related communication skills, mostly nonverbal, are critical for high-quality care and influence patient satisfaction, adherence, and outcomes. (Roter et al., 2005)24

42. Nonverbal Behavior and Communication How does this apply to Physician-Patient interaction? (cont.)Nonverbal behaviors contribute to the development of trust and rapport, as well as the establishment and maintenance of relationships with patients. (Ambady et al., 2002)Nonverbal behavior is the most essential way to convey empathy with patients. (Bensing et al., 1995)25

43. Nonverbal Behavior and Communication Specific Examples:Head nods, open arm positions, and forward leans are thought to convey encouragement and interest.Body position has been related to patients’ perception of warmth and empathy.Smiles convey approval or agreement, frowns disapproval. Blank expressions may convey boredom, aloofness, or dismissal.26