This presentation is part of: Poster Session - Clinical Strategies; Judgment and Decison Making
UP-CLOSE-AND-PERSONAL: UNDERSTANDING PHYSICIAN DECISION-MAKING THROUGH VIDEOTAPES OF PATIENT-PHYSICIAN INTERACTIONS
Ming Tai-Seale, PhD, MPH, Texas A&M University Health Science Center, Health Policy and Management, Bryan, TX
Background: A decision is defined as a verbal commitment to a definitive course of action. Measuring the process of medical decision-making with micro-level interaction data may enhance our understanding of what happens in medical practices and how to change it to improve quality of care. Methods: Qualitative critical discourse analysis of videotaped visits complements quantitative investigations which involve designing a coding system to capture the process, content, and rapport of patient-physician information exchange prior to a medical decision and econometric analyses. Duration model explores the role of patient information input in physician's decision-making. The unit of analysis is each topic covered in a visit. Results: Critical discourse analysis revealed that physicians often did not address patients' key concerns. Affective issues particularly received little attention and were frequently marginalized. Quantitative analyses showed that patients talked for less than 1 minute while it took less than 3 minutes to reach a decision regarding a topic. Patients initiated 45% of the topics and each visit contained an average of 5 topics. Though patients showed verbal or nonverbal cues of mood disorder in over 15% of the topics, only 6% of them involved discussion of affective issues. Patients spoke more than twice as long in emotional topics compared with in other topics. Robust hazard ratios from the duration model were obtained after accounting for the clustering effect of patient-physician pairs. Hazard ratios suggested that patients talked longer when they had initiated the topic, the topic was about emotions, physician showed personal uncertainties, patient showed verbal cues of emotional distress, patient had private insurance, and when patient had better mental health status. The late onset of a topic, being in a managed care organization, longer length of patient-physician relationship, and better scores in physical role functioning, pain, and vitality were associated with shorter patient talk time and short time it took to reach a decision. Conclusions: Studying the process of care using videotapes of patient visits provides new insights on decision-making. The dynamics of communication play a significant role in patient-physician interaction. Patients should be advised to initiate topics that are important to them early in the visit so that they can give sufficient information on their preferences and receive needed information from their physicians before a decision is made.
