Family orientation in patient care has long been one of the primary tenets of the practice of family medicine. Yet we know surprisingly little about how frequently family-oriented transactions occur in actual doctor-patient encounters, or about what other aspects of physician communication patterns might be associated with increased family orientation. The purpose of this study was to investigate both frequency and correlates of family orientation in a residency-based practice.
Sixty videotapes representing 38 second and third-year residents interviewing a range of multiethnic patients over a 2-year period at a community clinic were analysed for evidence of family-oriented communications, as well as other interaction behaviours such as information exchange and partnership building. Inter-rater agreement was 78%.
Asking for medical information, clarifying patient information, and giving medical information and explanations were the most common types of resident actions. Family orientation was much less common, but was more frequently observed than the eliciting of a patient-centered agenda or suggestion of a psychosocial intervention or referral. Family orientation was associated with longer interviews, non-interpreted interviews, more physician questions and clarifying behaviours, and greater tendency to elicit the patient's agenda.
Findings of this investigation suggest that family orientation in the medical interview is enhanced by having more time and a shared language, as well as a generally probing, clarifying, patient-centered style on the part of the physician.