Physicians’ and Patients’ Interruptions in Clinical Practice: A Quantitative Analysis

Abstract

PURPOSE Physicians' interruptions have long been considered intrusive, masculine actions that inhibit patient participation, but a systematic analysis of interruptions in clinical interaction is lacking. This study aimed to examine when and how primary care physicians and patients interrupt each other during consultations. METHODSWe coded and quantitatively analyzed interruption type (cooperative vs intrusive) in 84 natural interactions between 17 primary care physicians and 84 patients with common somatic symptoms. Data were analyzed using a mixed-effects logistic regression model, with role, gender, and consultation phase as predictors. RESULTSOf the 2,405 interruptions observed, 82.9% were cooperative. Among physicians, men were more likely to make an intrusive interruption than women (β = 0.43; SE, 0.21; odds ratio [OR] = 1.54; 95% CI, 1.03-2.31), whereas among patients, men were less likely to make an intrusive interruption than women (β = −0.35; SE, 0.17; OR = 0.70; 95% CI, 0.50-0.98). Patients' interruptions were more likely to be intrusive than physicians' interruptions in the phase of problem presentation (β = 0.71; SE, 0.23; OR = 2.03; 95% CI, 1.30-3.20), but not in the phase of diagnosis and/or treatment plan discussion (β = −0.17; SE, 0.15; OR = 0.85; 95% CI, 0.63-1.15). CONCLUSIONS Most interruptions in clinical interaction are cooperative and may enhance the interaction. The nature of physicians' and patients' interruptions is the result of an interplay between role, gender, and consultation phase.

Observational study on the timing and method of interruption by hospital consultants during the opening statement in outpatient consultations

“…Given the increased attention to patient-centred communication in medical curricula and the lay press, the available literature may therefore not represent current medical practice regarding the interruption of patients during their opening statement. Finally, the currently available literature on interruptions in medical consultations rarely distinguishes between different types of interruptions, which may be relevant because recent studies have shown that not all interruptions have a negative effect, [27][28][29][30] and that some interruptions may also have supportive and affirming functions in the consultation. [30][31][32] This study aimed to analyse hospital consultants' verbal interruption behaviour during the opening statement of their patients, considering various forms of interruptions and their effects on the doctor-patient consultation.…”

“…Finally, the currently available literature on interruptions in medical consultations rarely distinguishes between different types of interruptions, which may be relevant because recent studies have shown that not all interruptions have a negative effect, 27–30 and that some interruptions may also have supportive and affirming functions in the consultation. 30–32 …”

Gender scores in epidemiological research: methods, advantages and implications

“… 1 The effects of sex and gender of patients are seen across symptoms, 2 diseases, 1 and throughout all phases of the patients’ illness trajectories. Differences between women and men are identified in the biopsychosocial etiology and persistence of somatic symptoms, 3 , 4 , 5 help-seeking behaviors, 6 medical communication about symptoms, 7 provided diagnostic interventions, 8 and efficacy of treatment. 9 …”