Elsevier

Surgery

Volume 125, Issue 2, February 1999, Pages 127-134
Surgery

Original Communications
Communication between surgeons and patients in routine office visits,☆☆

https://doi.org/10.1016/S0039-6060(99)70255-2Get rights and content

Abstract

Background: Research conducted in primary care settings has demonstrated that effective communication enhances patient recall of information, compliance, satisfaction, psychologic well-being, and biomedical outcomes. However, surgeons face communication challenges that are unique to the surgical situation. This study provides the first description of routine communication between community-practicing surgeons and their patients. Methods: Audiotapes of 676 routine office visits with 29 general surgeons and 37 orthopedic surgeons were coded for structure and content. Descriptive analysis of quantitative data is supplemented by illustrative examples of dialog selected to represent typical patterns of communication. Results: The mean visit length was 13 minutes. Surgeons talked more than patients, with typical surgical consultations containing relatively high amounts of patient education and counseling. Consultations had a narrow biomedical focus with little discussion of the psychologic aspects of patient problems. The affective tone of visits was generally positive, with few instances of overt criticism or disagreement by either party. However, surgeons infrequently expressed empathy toward patients, and social conversation was brief. Conclusions: The study underscores the differences in both the content and process of routine surgical visits compared with primary care visits. On the basis of this work, it seems particularly important for surgeons to develop skills that enhance patient education and counseling. Further research is needed to understand the influences of surgeons' communication on patient behavioral, psychologic, and biomedical outcomes. (Surgery 1999;125:127-34.)

Section snippets

Study design and subjects

This study used data from a larger research project examining the relationship of physician-patient communication with physicians' malpractice history.17 The Institutional Review Board of Legacy Good Samaritan Hospital, Portland, Oregon, approved the study. As part of the research, 676 audiotapes of routine office visits with surgeons were coded for structure and content. Both physicians and patients completed exit questionnaires assessing patient and physician demographic information and the

Visit characteristics

The mean visit time was 12.7 minutes (SD 7.9) for orthopedic surgery consultations and 13.1 minutes (SD 11.2) in general surgery. Approximately 18% of patients were seeing the surgeon for the first time. The most frequent diagnoses recorded by orthopedic surgeons were injuries to the rotator cuff of the shoulder, anterior cruciate ligament of the knee, lateral or medial meniscus of the knee, ankle fractures, carpal tunnel syndrome, and low back pain. The most frequent diagnoses recorded by

Discussion

Overall, the content of discussions between surgeons and patients focused on biomedical issues, with the largest percentage of time devoted to dialogs about patients' medical conditions and treatment options. In fact, almost half the visits were dedicated to the patient education and counseling phase during which surgeons educated patients by giving them information. This seems consistent with the work of physicians in this setting because they often see patients referred to them for a surgical

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      However, it has become increasingly more supported that surgeons should practice empathy beyond the critical moments of reporting complications or poor surgical outcomes. Descriptive studies examining surgeon communication with patients find that surgeons overwhelmingly spend most of their time exchanging biomedical information, using close-ended questions, and rarely touching upon emotional and psychosocial aspects of care.12,20 Studies tend to report surgeon response to empathic opportunities at only 10%-30%12; Braddock examined 89 orthopaedic surgeons and found that patients only fully disclosed 53% of their real concerns about surgery to the surgeon, rarely bringing up issues like lack of social support and other barriers to surgery.21

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    Supported in part by Agency for Health Care Policy and Research R01 grant No. 07289.

    ☆☆

    Reprint requests: Wendy Levinson, MD, University of Chicago Medical Center, 5841 S Maryland Ave, MC 6098, Chicago, IL 60637.

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