Patients, interrupted?
To the editor:
As part of the excellent article by Carney and colleagues1 on physician communication and depression, the authors state that they found no instances of physicians interrupting the patient to redirect the encounter. This was viewed in contrast to our study,2 in which we found that patients frequently were not allowed to articulate their full range of concerns before the conversation became more focused.
This seeming disparity may be a result of different definitions of the word “interruption.” We did not use the term “interruption” in our study. We prefer the term “redirection,” in which the physician directs the patient to provide further details on one specific concern before exploring the full range of patient concerns in a more open-ended fashion. In contrast, an interruption, as defined by Templeton and Allen,3 occurs when “the physician interrupts the patient’s verbalization before the thought has been completed, and interrupts and breaks into the patient’s statement before the patient has completed the thought.”
We suggest that reanalysis of their data using our criteria1 would yield different results.
M. Kim Marvel, PhD
Fort Collins, Colorado
Ronald M. Epstein, MD
Howard B. Beckman, MD
University of Rochester
New York
- Carney PA, Eliassen S, Wolford GL, Owen M, Badger LW, Dietrich AJ. How physician communication influences recognition of depression in primary care. J Fam Pract 1999; 48:958-64.
- Marvel MK, Epstein RM, Flowers K, Beckman H. Soliciting the patient’s agenda: have we improved? JAMA 1999; 281:283-7.
- Templeton B, Allen MM. ISIE-81 coding manual. Philadelphia, Pa: Department of Mental Health Sciences, Hahnemann University; 1991.
The preceding letter was referred to drs carney and dietrich who responded as follows:
We are grateful for the letter from Marvel and colleagues. They suggest that a key distinction exists between the terms “interruption” and “redirection” used to classify certain physician communication behaviors in our respective studies.1,2 Our study found no instances where patients were “interrupted” as defined by the methodology we used3 (ie, the patient’s verbalization was interrupted by the physician before the thought was completed). Their study found that patients were frequently “redirected” as defined by their methodology4 (ie, the physician redirects the patient to provide further details on one specific concern before exploring the full range of patient concerns).
Which is it? Do physicians interrupt patients too soon? And what effect, if any, does either redirection or interruption have on patients’ cognitive thought patterns and their ultimate health outcomes? We hypothesize that either may influence patient agenda setting, since they both interrupt patient thinking. The Interaction System for Interview Evaluation analysis used in our paper does not include a code directly comparable with redirection. We look forward to engaging help from Marvel and coworkers in reanalyzing both our data set and theirs to shed light on these important questions. Understanding this phenomenon (called either redirection or interruption) would assist researchers and clinicians in better understanding how physician communication patterns can improve patient outcomes.
Patricia A. Carney, PhD
Allen J. Dietrich, MD
Dartmouth Medical School
Hanover, New Hampshire
- Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA 1999; 281:283-7.
- Carney PA, Eliassen MS, Wolford G, Owen M, Badger LW, Dietrich AJ. How physician communication influences recognition and management of depression. J Fam Pract 1999; 48:958-64.
- Templeton B. McDonald M. Use of interactional analysis in assessing physician trainee interpersonal skills and clinical performance. In: Lloyd JD, ed. Evaluation of noncognitive skills and clinical performance. Chicago, Ill: American Board of Medical Specialties; 1982:155-67.
- Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med 1984; 101:692-6.