• D L Roter, M Stewart, S M Putnam, M Lipkin, W Stiles, and T S Inui.
• Department of Health Policy and Management, the Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md 21205, USA. DROTER@phnet.sph.jhu.edu
• JAMA. 1997 Jan 22; 277 (4): 350356350-6.

ObjectivesTo use audiotape analysis to describe communication patterns in primary care, to relate these to ideal relationship types as described in the literature, and to explore the patterns' relationships with physician and patient characteristics and satisfaction.DesignDescription of routine communication in primary care based on audiotape analysis and patient and physician exit questionnaires.SettingA total of 11 ambulatory clinics and private practices.ParticipantsThe participants were 127 physicians and 537 patients coping with ongoing problems related to disease.Main Outcomes MeasuresRoter Interactional Analysis System (RIAS) and patient and physician exit satisfaction questionnaires.ResultsCluster analysis revealed 5 distinct communication patterns: (1) "narrowly biomedical," characterized by closed-ended medical questions and biomedical talk occurring in 32% of visits; (2) "expanded biomedical," like the restricted pattern but with moderate levels of psychosocial discussion occurring in 33% of the visits; (3) "biopsychosocial," reflecting a balance of psychosocial and biomedical topics (20% of the visits); (4) "psychosocial," characterized by psychosocial exchange (8% of visits); and (5) "consumerist," characterized primarily by patient questions and physician information giving (8% of visits). Biomedically focused visits were used more often with more sick, older, and lower income patients by younger, male physicians. Physician satisfaction was lowest in the narrowly biomedical pattern and highest in the consumerist pattern, while patient satisfaction was highest in the psychosocial pattern.ConclusionsPrimary care communication patterns range from narrowly biomedical to consumerist patterns and parallel the ideal forms of patient-physician relationships described in the literature.

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