Measuring patient and physician participation in exchanges on medications: Dialogue Ratio, Preponderance of Initiative, and Dialogical Roles.

Abstract

OBJECTIVE: To identify, describe and characterize the patient and physician participation in content production in medication-related exchanges during primary care consultations. METHODS: Descriptive study of audio recordings of 422 medical encounters. MEDICODE, a validated instrument was used to analyze verbal exchanges on medications. Two main indicators of participation were developed: Dialogue Ratio (DR), a 0-1 scale indicating extent of monologue/dialogue; Preponderance of Initiative (PI), a -1 to +1 scale for patient/physician initiative. Participation analyses were conducted by content theme and medication categories (New, Represcribed and Active). RESULTS: We identified 1492 discussions of medications. Categorical analyses identified four communication roles patients and physicians adopted when participating in medication-related exchanges during consultations: (a) Listener, (b) Information Provider, (c) Participant, and (d) Instigator. The mean observed DRs and PIs indicated that monologues and physician initiation dominated medication-related exchanges. CONCLUSION: Four factors are suggested to explain the communicational behaviors observed: (1) patient knowledge about medications, (2) physician expertise, (3) patient experience with the medication, and (4) the act of prescribing. Our data indicate a generally low level of dialogue when discussing medications during primary care encounters since physicians' monologues seem to be the rule rather than the exception, pointing to a lack of mutuality in exchanges on medications. PRACTICE IMPLICATIONS: The proposed concepts offer a unique vocabulary and conceptual framework to help physicians master the necessary content and process skills required to discuss medications with patients.