Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits

By Debra L. Roter; Judith A. Hall | Go to book overview

5
Patterns of Talk in the Medical Visit

By most estimates, the average primary care medical visit in the United States lasts less than twenty minutes--about fourteen minutes for family practice and nineteen minutes for internal medicine ( Nelson & McLemore, 1988). Although there is a good deal of variation, with some visits as short as thirty seconds and others as long as an hour or more, most of the complicated business of healing is accomplished in relatively short, sporadic encounters. In this chapter the medical encounter will be described, including what a doctor is likely to say and what a patient is likely to say back. For the most part, the description will reflect visits to doctors' offices, although for a point of reference it will relate what we know about patients' talk with doctors in the hospital. The charts and figures presented in this chapter are based on actual observation of thousands of routine medical encounters.

Direct observation of medical visits has not had a very long tradition. Despite intense interest in the therapeutic encounter dating back to the days of Hippocrates, it has only been since the late 1960s, with advances in recording technology, that the medical encounter has been systematically observed. Perhaps because of the physical exposure of the exam there is an element of privacy to the medical visit that has discouraged the researcher's intrusion. But physical exposure is only one aspect of the visit that is considered private; discovery of illness, and the fears and vulnerabilities that may accompany it, are also intensely private. Legal structures and professional ethics have surrounded the visit to ensure that these discussions can be open and free from fear. Confidentiality is jealously

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