Improved health outcomes in integrative medicine visits may reflect differences in physician and patient behaviors compared to standard medical visits

PATIENT EDUCATION AND COUNSELING

卷:104

Article

Dossett, Michelle L.^1,2,3,4  Hall, Judith A.⁵  Kaptchuk, Ted J.⁴  Yeh, Gloria Y.⁴ 

[1] Univ Calif Davis, Div Gen Internal Med Geriatr & Bioeth, Sacramento, CA 95817 USA

[2] Massachusetts Gen Hosp, Div Gen Internal Med, Boston, MA 02114 USA

[3] Massachusetts Gen Hosp, Benson Henry Inst Mind Body Med, Boston, MA 02114 USA

[4] Beth Israel Deaconess Med Ctr, Div Gen Med, Boston, MA 02215 USA

[5] Northeastern Univ, Dept Psychol, Boston, MA 02115 USA

关键词: Physician-patient relations;    Gastroesophageal reflux;    Integrative medicine;    Patient-Centered care;    Nonverbal communication;    Video recording;   

DOI  :  10.1016/j.pec.2020.07.014

来源: Elsevier

【 摘 要 】

Objective: To identify differences in patient-physician interactions associated with improvements in GERD symptoms in a randomized controlled trial comparing integrative medicine and primary care/standard visits. Methods: We analyzed video recordings of 2-minute excerpts (thin slices) from the beginning, middle, and end of 21 study visits (11 standard, 10 integrative medicine). Results: According to blind coders' analysis of the excerpts, prospective improvement in GERD symptoms was most highly correlated with patients appearing pleased (r = 0.71, p < 0.01) and friendly (r = 0.67, p < 0.01) at the end of the visit, controlling for visit type. The combination of patient and physician smiling at the end of the visit was associated with improvement in GERD symptoms (r(2) = 0.45, p = 0.004). The physician in the integrative visits was more engaged (p = 0.009), friendly (p = 0.005), relaxed (p = 0.002), smiled longer (p = 0.006), gazed longer (p = 0.02), and gestured more (p = 0.007), compared to standard visits. Patients in integrative visits also smiled longer (p = 0.004). Conclusion: The expanded history-taking questions asked by integrative clinicians may enhance relationship building, modifying patients' responses and improving patient-centered behaviors from clinicians,ultimately facilitating symptom improvement. Practice Implications: Analysis of nonverbal behaviors may facilitate a better understanding of patientclinician interactions in integrative medicine visits and yield insights to improve clinical interactions in conventional medicine. (C) 2020 Elsevier B.V. All rights reserved.

【 授权许可】

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