Communication between surgeons and patients in routine office visits (see comments)

摘要

BACKGROUND: Research conducted in primary care settings has demonstrated that effective communication enhances patient recall of information, compliance, satisfaction, psychologic well-being, and biomedical outcomes. However, surgeons face communication challenges that are unique to the surgical situation. This study provides the first description of routine communication between community-practicing surgeons and their patients. METHODS: Audiotapes of 676 routine office visits with 29 general surgeons and 37 orthopedic surgeons were coded for structure and content. Descriptive analysis of quantitative data is supplemented by illustrative examples of dialog selected to represent typical patterns of communication. RESULTS: The mean visit length was 13 minutes. Surgeons talked more than patients, with typical surgical consultations containing relatively high amounts of patient education and counseling. Consultations had a narrow biomedical focus with little discussion of the psychologic aspects of patient problems. The affective tone of visits was generally positive, with few instances of overt criticism or disagreement by either party. However, surgeons infrequently expressed empathy toward patients, and social conversation was brief. CONCLUSIONS: The study underscores the differences in both the content and process of routine surgical visits compared with primary care visits. On the basis of this work, it seems particularly important for surgeons to develop skills that enhance patient education and counseling. Further research is needed to understand the influences of surgeons' communication on patient behavioral, psychologic, and biomedical outcomes.