[German translation and construct validation of the Patient-Provider-Orientation Scale (PPOS-D12)]. / Deutsche Übersetzung und Konstruktvalidierung des "Patient-Provider-Orientation Scale" (PPOS-D12).

The aim was to translate the Patient-Provider Orientation Scale (PPOS) into German and to assess the degree of medical students' patient-centeredness in 2 student samples in Freiburg (GER) and in Basel (CH). The German translation of PPOS was administered to 259 medical students in Freiburg and to 137 medical students in Basel. Construct validity was tested using factor analysis. Based on factor analysis and tests of internal consistency, a shortened version with 6 items for each of the 2 subscales "sharing" and "caring" was generated (PPOS-D12). PPOS D12 is a reliable instrument to assess patient-centeredness among medical students in German-speaking countries.

Looking for trouble: the added value of sequence analysis in finding evidence for the role of physicians in patients' disclosure of cues and concerns.

BACKGROUND: Not knowing patient concerns can lead to misunderstandings, incomplete diagnoses, patient dissatisfaction, and nonadherence. Although many studies show relations between physician communication and patients' expression of cues or concerns, most of these studies are cross-sectional, thus limiting the interpretation of these relationships. Sequence analysis can show the immediate effects of physician communication behaviors. OBJECTIVE: To show the added value of sequence analysis in finding evidence for the role of physician communication in patients' disclosure of cues and concerns. RESEARCH QUESTIONS: Which physician communication predicts patients' expression of cues or concerns when using 2 different types of analysis: sequence analysis and cross-sectional analysis? METHODS: In a sample of 99 videotaped medical encounters with hypertensive patients in General Practice, we coded communication with Roter Interaction Analysis System and timed physician eye contact. For the cross-sectional analyses, we performed Poisson regression analyses to establish which physician communication is related to the total amount of patient cues and concerns. For the sequential analyses, we performed logistic regression analyses to establish which physician communication is directly followed by cues or concerns. We report incidence rate ratios and odds ratios (ORs), respectively. RESULTS: Both methods show that physicians' facilitative communication (1.21 and 2.33, respectively), eye contact (1.02 and 1.51, respectively), and psychosocial questions (2.42 and 3.50, respectively) are related to more disclosure of cues and concerns. Moreover, sequence analysis shows that patients' expression of cues or concerns is less often preceded by physician social talk (OR = 0.49), giving instructions (OR = 0.38) and providing biomedical information (OR = 0.45) or counseling (OR = 0.39). In the cross-sectional analyses, these relations are absent or-before controlling for confounding variables-even in the opposite direction. All reported results are significant at P < 0.01 or P < 0.001. CONCLUSIONS: Although cross-sectional analyses and sequence analyses show grossly the same results, sequence analysis is more precisely in demonstrating the direct influence of physician communication on subsequent cues and concerns by the patient. Physicians should avoid long monologues with medical information and should use facilitative communication, eye contact, and psychosocial questions to help patients express themselves.

[Evaluation of a two year curriculum in psychosocial and psychosomatic medicine--handling emotions and communicating in a patient centred manner]. / Evaluation eines zweijährigen Curriculums in Psychosozialer und Psychosomatischer Medizin--Umgang mit Emotionen und patientenzentrierter Gesprächsführung.

Psychosomatic Medicine is aiming at a comprehensive understanding of patient's requests. This requires patient-centred communication. During the two-year course for "Psychosomatic Medicine"of the Lower-Austrian Medical Chamber at the Danube-University Krems relevant techniques are trained. This paper reports on the analysis of 120 video-consultations with simulated patients (30 participants, two per participant before and after the training) using a modified version of the Roter Interaction Analysis System (RIAS). Results show a considerable increase in participant's ability to respond to emotional utterances and to use techniques of patient-centred communication: percentage of appropriate utterances related to the sum of all utterances: from 9.78 ± 3.5 to 13.56 ± 4.7 (ANOVA with repeated measures: p<0.001). Furthermore, participants allow patients longer stretches of uninterrupted speech: increase from 1.76 ± 1.4 to 2.47 ± 2.3 utterances (p<0.001) helping them into a narrative style of conversation.

Do patients respect the line? Transgression of boundaries reported by Swiss general practitioners.

OBJECTIVE: Transgression of boundaries in the relationship between physician and patient is commonly studied with patient as victim and physician as transgressor. A recent survey in the U.S. reported that almost 90% of physicians face transgression by patients over one year. Incidents happened mainly through verbal abuse, disregarding privacy, and overly affectionate behavior. Since this incidence seems to be alarmingly high, we were interested to analyze how often general practitioners in Switzerland experience transgression by patients. METHODS: 24% of the members of the Swiss Society of Internal Medicine (SGIM) and of the Swiss Society of General Medicine (SGAM) (n=675/2781) responded to an internet-based survey which asked for experiences of transgression by patients and for physicians' responses to transgression in the last 12 months. RESULTS: 81% of responding physicians experienced transgression over the period of one year. Analyzing the frequency of incidents per physician per year, the most common forms of transgression were 'use of physician's first name' (7.7/y), 'asking personal questions' (1.8/y), 'being verbally abusive' (1.5/y), and 'being overly affectionate' (1.4/y). Calculated incidence of transgression was 3 per 1000 patient contacts. 39% of physicians decided to ignore the incident, 37% discussed the event openly. Transgression led to dismissal of patients in 13% of events. CONCLUSION: Transgression even in mild and modest form is a rare phenomenon in Swiss practices. PRACTICE IMPLICATION: The Swiss data do not suggest that there is a specific risk for Swiss practitioners to be exposed to major transgression for which they should specifically be prepared for example in communication skills trainings.

From patient talk to physician notes-Comparing the content of medical interviews with medical records in a sample of outpatients in Internal Medicine.

OBJECTIVES: An increasing number of consultations are delivered in group practices, where a stable 1:1 relationship between patient and physician cannot be guaranteed. Therefore, correct documentation of the content of a consultation is crucial to hand over information from one health care professional to the next. METHODS: We randomly selected 20 interviews from a series of 56 videotaped consultations with patients requesting a general check-up exam in the outpatient department of Internal Medicine at the University Hospital Basel. All patients actively denied having any symptoms or specific health concerns at the time they made their appointment. Videotapes were analysed with the Roter Interaction Analysis System (RIAS). Corresponding physician notes were analysed with a category check-list that contained the information related items from RIAS. RESULTS: Interviews contained a total of 9.002 utterances and lasted between 15 and 53min (mean duration: 37min). Patient-centred communication (Waiting, Echoing, Mirroring, Summarising) in the videos significantly correlated with the amount of information presented by patients: medical information (r=.57; p=.009), therapeutic information (r=.50; p=.03), psychosocial information (r=.41; p=.07), life style information (r=.52; p=.02), and with the sum of patient information (r=.64; p=.003). Even though there was a significant correlation between the amount of information from the video and information in physician's notes in some categories (patient gives medical information; Pearson's r=.45; p=.05, patient gives psychosocial information; Pearson's r=.49; p=.03), an inspection of the regression lines shows that a large extent of patient information is omitted from the charts. Physicians never discussed with patients whether information should be documented in the charts or omitted. CONCLUSIONS: The use of typical patient-centred techniques increases information gathered from patients. Physicians document only a small percentage of patient information in the charts, their 'condensing heuristic' is not shared with patients. PRACTICE IMPLICATIONS: Patient involvement should be advocated not only to medical decision making but also to the way physicians document the content of a consultation. It is a joint responsibility of patient and health care professional to decide, which information should be kept and thus be communicated to another health care professional in future consultations.