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Decision or No Decision: How Do Patient–Physician Interactions End and What Matters?

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Background

A clearly stated clinical decision can induce a cognitive closure in patients and is an important investment in the end of patient–physician communications. Little is known about how often explicit decisions are made in primary care visits.

Objective

To use an innovative videotape analysis approach to assess physicians’ propensity to state decisions explicitly, and to examine the factors influencing decision patterns.

Design

We coded topics discussed in 395 videotapes of primary care visits, noting the number of instances and the length of discussions on each topic, and how discussions ended. A regression analysis tested the relationship between explicit decisions and visit factors such as the nature of topics under discussion, instances of discussion, the amount of time the patient spoke, and competing demands from other topics.

Results

About 77% of topics ended with explicit decisions. Patients spoke for an average of 58 seconds total per topic. Patients spoke more during topics that ended with an explicit decision, (67 seconds), compared with 36 seconds otherwise. The number of instances of a topic was associated with higher odds of having an explicit decision (OR = 1.73, p < 0.01). Increases in the number of topics discussed in visits (OR = 0.95, p < .05), and topics on lifestyle and habits (OR = 0.60, p < .01) were associated with lower odds of explicit decisions.

Conclusions

Although discussions often ended with explicit decisions, there were variations related to the content and dynamics of interactions. We recommend strengthening patients’ voice and developing clinical tools, e.g., an “exit prescription,” to improving decision making.

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Acknowledgments

The authors thank Michele Greene for providing the coding guide for the Multidimensional Interaction Analysis (MDIA) system and Thomas McGuire, Charles Huber, Emil Berkanovic, Suojin Wang, three anonymous reviewers, and the Deputy Editor Richard Frankel for helpful comments. Funding from NIMH MH0193, NIA AG 15737, and the Texas A&M Health Science Center School of Rural Public Health and the Scott & White Health Plan Health Services Research Program is gratefully acknowledged.

Potential Financial Conflicts of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center, TAMU 1266, College Station, Texas, 77843-1266, USA

    Ming Tai-Seale PhD, MPH & Xiaoming Bao MS, MS

  2. Department of Family and Community Medicine and Scott & White Clinic, College of Medicine, Texas A&M Health Science Center, College Station, Texas, USA

    Rachel Bramson MD, MS

Authors
  1. Ming Tai-Seale PhD, MPH
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  2. Rachel Bramson MD, MS
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  3. Xiaoming Bao MS, MS
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Correspondence to Ming Tai-Seale PhD, MPH.

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Tai-Seale, M., Bramson, R. & Bao, X. Decision or No Decision: How Do Patient–Physician Interactions End and What Matters?. J GEN INTERN MED 22, 297–302 (2007). https://doi.org/10.1007/s11606-006-0086-z

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