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Patient cues and medical interviewing in general practice: examples of the application of sequential analysis

Published online by Cambridge University Press:  11 October 2011

Christa Zimmermann ,
Lidia Del Piccolo  and
Maria Angela Mazzi
Christa Zimmermann*
Affiliation:
Department of Medicine and Public Health, Service of Medical Psychology, University of Verona, Verona, Italy
Lidia Del Piccolo
Affiliation:
Department of Medicine and Public Health, Service of Medical Psychology, University of Verona, Verona, Italy
Maria Angela Mazzi
Affiliation:
Department of Medicine and Public Health, Service of Medical Psychology, University of Verona, Verona, Italy
*
Address for correspondence: Professor Ch. Zimmermann, Department of Medicine and Public Health, Section of Psychiatry, Service of Medical Psychology, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona (Italy). Fax: +39-045-585871 E-mail: [email protected]
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Summary

Aims – To illustrate how sequence analysis may be applied to the medical interview to: 1. explore how physicians without formal training in communication skills elicit and respond to patient cues and expression of expectations and opinions; and 2. test the hypothesis that physicians' closed ended questions determine the use of subsequent closed ended questions. Methods – 238 consultations in primary care, coded with the Verona Medical Interview Classification System, were analysed. Lag 1 analysis was applied to study which physician behaviour precedes and follows patient cues. Pattern recognition analysis for five lag sequences was performed to test the occurrence of predefined specific code chains, where a closed and an open ended question were followed either by two closed-ended questions or by two patient facilitating interventions Results – Patients' cue offers were most likely after facilitative interventions, but not after open-ended questions; physicians were most likely to respond to these expressions with facilitation. Physicians' tendency to use closed ended questions increased after previous closed questions and decreased after an open-ended question. Conclusions – Lag sequential analysis and pattern recognition analysis are useful methods to study exploratory and theory driven hypotheses and allow an initial approach to validate the supposed appropriateness of specific physician interventions.

Declaration of Interest: none.

Keywords

sequence analysismedical interviewVR-MICS.
Type
Sequence Analysis of Patient-Provider Interaction
Information
Epidemiology and Psychiatric Sciences , Volume 12 , Special Issue 2: Sequence Analysis of Patient-Provider Interaction , June 2003 , pp. 115 - 123
Copyright
Copyright © Cambridge University Press 2003

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