Concordance Between Physicians and Their Older and Younger Patients in the Primary Care Medical Encounter

Greene, Michele G.; Adelman, Ronald D.; Charon, Rita; Friedmann, Erika

doi:10.1093/geront/29.6.808

Cited by 71 publications

(41 citation statements)

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“…An ecological approach is unique to traditional approaches to the study of communication in medical encounters. For example, some studies take a 'single factor' approach by examining the influence of one variable such as gender (Hall & Roter, 1998) or age (Greene, Adelman, Charon & Friedmann, 1989) on physician-patient encounters. However, the influence of any one variable (e.g., ethnicity) may vary depending on the presence of other factors (e.g., the patient's level of education, the physicians' communication style).…”

Section: Conceptual Framework: An Ecological Approachmentioning

confidence: 99%

Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?

Street

Gordon

Haidet

2007

Social Science & Medicine

451

359

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Although physicians' communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with patients. Moreover, while any number of factors may affect the communication process, few studies have analyzed these effects collectively in order to identify the most powerful influences on physician communication and perceptions. Adopting an ecological approach, this investigation examined: (a) the relationships of physicians' patient-centered communication (informative, supportive, partnership-building) and affect (positive, contentious) on their perceptions of the patient, and (b) the degree to which communication and perceptions were affected by the physicians' characteristics, patients' demographic characteristics, physician-patient concordance, and the patient's communication. Physicians (N = 29) and patients (N = 207) from 10 outpatient settings in the United States participated in the study. From audio-recordings of these visits, coders rated the physicians' communication and affect as well as the patients' participation and affect. Doctors were more patientcentered with patients they perceived as better communicators, more satisfied, and more likely to adhere. Physicians displayed more patient-centered communication and more favorably perceived patients who expressed positive affect, were more involved, and who were less contentious. Physicians were more contentious with black patients, whom they also perceived as less effective communicators and less satisfied. Finally, physicians who reported a patient-centered orientation to the doctor-patient relationship also were more patient-centered in their communication. The results suggest that reciprocity and mutual influence have a strong effect on these interactions in that more positive (or negative) communication from one participant leads to similar responses from the other. Physicians' encounters with black patients revealed communicative difficulties that may lower quality of care for these patients.

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Section: Conceptual Framework: An Ecological Approachmentioning

confidence: 99%

Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?

Street

Gordon

Haidet

2007

Social Science & Medicine

451

359

View full text Add to dashboard Cite

show abstract

“…For instance, it is possible that younger women were more assertive and initiated discussion and requested cancer screening more often than did older women, who were more likely to be passive and modest. 33,34 Future qualitative research is needed to confirm this hypothesis and disentangle the dynamic physician-patient communication process.…”

Section: Factors Associated With Physicians' Cancer Screening Recommementioning

confidence: 99%

Language Use and the Receipt of Cancer Screening Recommendations by Immigrant Chinese American Women

Liang

Wang

Chen

et al. 2009

Journal of Women's Health

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Background: Cancer screening rates are low among Chinese American women, a mostly immigrant minority population. This is possibly because they do not receive cancer screening recommendations from their physicians. The objective of this study was to determine if the rate at which physicians recommend cancer screening to older Chinese American women differs according to the language used during visits. Methods: Data for the cross-sectional study were collected from a telephone survey of older Chinese American women residing in the Washington, DC, area. A total of 507 asymptomatic Chinese American women aged Ն50 who had a regular physician participated in this study. The main outcome was women's self-reported perception of having received a recommendation from their physician for mammography, Pap tests, or colorectal cancer screening in the past 2 years. The main independent variable was the language used during visits (English vs. Chinese). Patient age, educational level, employment status, cultural views, physician specialty, physician gender, and length of relationship with the physician were included in the multiple logistic regression analyses. Results: Chinese women who communicated with their physicians in English were 1.71 (95% CI 1.00-2.96) and 1.73 (95% CI 1.00-3.00) times more likely to report having received mammography and colorectal cancer screening recommendations, respectively (p Ͻ 0.05). Physicians in family medicine or general practice were 2.11 (95% CI 1.31-3.40) and 1.70 (95% CI 1.06-2.48) times more likely to recommend cancer screening than those in other specialties. Conclusions: Chinese American women who conversed with their physicians in Chinese were less likely to perceive receiving cancer screening recommendations. Future research is needed to identify physician-specific knowledge, attitude, and cultural barriers to recommending cancer screening.

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“…[3][4][5][6][7] Differences may stem from many factors, including greater numbers of problems treated, 4 poorer health status among older patients, 5 and different preferences for content of interaction. 8 Greene and her colleagues 7 identified lower levels of psychosocial content in the visits of older patients and found that older patients agree with their primary care physician about the purpose of the visit less than do younger patients.…”

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confidence: 99%

“…8 Greene and her colleagues 7 identified lower levels of psychosocial content in the visits of older patients and found that older patients agree with their primary care physician about the purpose of the visit less than do younger patients. 6 It is not clear whether the different content occurs because of different preferences on the part of older patients or reflects different approaches to care by physicians when facing older patients. Regardless, older patients generally report higher satisfaction with care than their younger counterparts.…”

mentioning

confidence: 99%

Physician-Elder Interaction in Community Family Practice

Callahan¹,

Stange²,

Zyzanski³

et al. 2004

The Journal of the American Board of Family Medicine

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Objective: To determine whether outpatient visits by elders seeing community family physicians differ in length or content from visits by younger patients; socioemotional preferences predict visit content; and satisfaction correlates with visit content differentially across age.Methods: In a multimethod cross-sectional study of 84 community family practices in northeastern Ohio, 3453 adult patient visits with 138 community family physicians were observed; 2362 of these patients completed self-report questionnaires. Three age groups were compared: 18 to 64, 65 to 74, and over 74 years. Length and content of the physician-patient encounter was determined using the Davis Observation Code (DOC); satisfaction was assessed using the MOS 9-item Visit Rating Scale. Medical breakthroughs during the 1900s have reduced early life mortality drastically and helped to swell the ranks of older people in this nation. 1Concerns about access to and quality of primary care for elders are growing as the numbers of people over 65 expands at an unprecedented rate.2,3

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Concordance Between Physicians and Their Older and Younger Patients in the Primary Care Medical Encounter

Cited by 71 publications

References 0 publications

Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?

Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?

Language Use and the Receipt of Cancer Screening Recommendations by Immigrant Chinese American Women

Physician-Elder Interaction in Community Family Practice

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