With today’s drastic social and environmental changes, people are involved in a recurring cycle of exhausting work and fleeting material pleasures. Under such conditions, people are more likely to suffer from psychosocial problems derived from maladaptation to such changes, which may further affect their physical and mental health. Health-affecting psychosocial problems are inherent in medical encounters and present among one third of patients for consultations (Parkerson et al., 1995; Gulbrandsen et al., 1998; Boerma & Verhaak, 1999). However, such problems are not always presented, and often easily overlooked by doctors. These psychosocial problems (e.g. change in social life, financial situations, living alone, fear of death, the loss of a spouse, aging, specific concerns or expectations, and so on) may result in patient dissatisfaction with health outcomes if left unaddressed (Beckman & Frankel, 1984; ten Have, 1989; Barry et al., 2000; Bell et al., 2001; Tsai, 2006). Therefore, the involvement of patients’ psychosocial problems is a crucial aspect of comprehensive medical care, and a vital step towards a more patient-centered communication. Given its significance, the current study aims to examine how doctors utilize psychosocial open questions to probe patient concerns by observing the interaction among doctors, patients and patients’ companions (patient parties hereafter). To explore this issue, there are four research questions examined, as follows. (1) What are the frequency distributions of Tsai’s (2006) general open questions (e.g. ‘why are you here today?’), biophysical open questions (e.g. ‘what are your symptoms?’) and psychosocial open questions (e.g. ‘are you worried about any problems recently?’) in medical encounters? (2) What is the relationship between psychosocial open questions in different contexts and patient parties’ various responses? (3) What are patient parties’ response patterns to biophysical and psychosocial open questions? (4) What are the subcategories of psychosocial open questions and patient parties’ responses to these subcategories? To examine these questions, transcriptions of 25 video-recorded medical encounters collected in the context of family medicine practice at a teaching hospital in southern Taiwan were observed. The participants included 11 doctors with a mean age of 35 years old (ranging from 29 to 40) and 25 elderly patients with a mean age of 73 years old (ranging from 62 to 81). All the 25 patients were visiting their doctors for the first time, and 88% of them were accompanied by one or two family members. The results of this work show that (1) the occurrence of psychosocial open questions (23.85%) was less frequent than general (39.23%) and biophysical open questions (36.92%), and a total of 31 psychosocial open questions were equally distributed in the medical history stage (48.4%) and family history stage (51.6%); (2) the ways that the patient parties tended to explicitly or not explicitly respond to psychosocial open questions in the two stages were different, based on whether these questions were relevant to local contexts; (3) by comparing responses to doctors’ biophysical an psychosocial open questions, patient parties responded to biophysical and psychosocial open questions differently based on four patterns, including ‘affirmative responses containing only information,’ ‘affirmations alone,’ ‘negations alone,’ and ‘delays before responses’; and (4) there are three subcategories of psychosocial open questions identified, including psychosocial open questions for ‘life changes’ (e.g. ‘are there any changes in your life recently?’), ‘unusual living arrangements’ (e.g. ‘do you have any special reasons to live alone?’), and ‘psychosocial distress’ (e.g. ‘are you worried about any problems recently?’); furthermore, patient parties tended to provide more descriptions of their problems to ‘life changes,’ less descriptions to ‘unusual living arrangements,’ and delays or repair initiators to ‘psychosocial distress.’ The above findings suggest that (1) the family history and medical history stages may be appropriate when doctors attempt to pose psychosocial open questions; (2) the family history stage may be more appropriate for doctors to ask psychosocial open questions, because a relevant context may facilitate doctors’ tasks of eliciting patients’ psychosocial concerns; (3) the three response patterns (i.e. ‘affirmations alone,’ ‘negations alone,’ and ‘delays before responses’) could be treated as hints that the patient parties may have unmentioned concerns; and (4) to ask effectively the subcategories of psychosocial open questions, doctors can have more use of ‘life changes’ and less or careful use of ‘psychosocial distress,’ especially the topics related to death information (e.g. the loss of a family member or having thoughts of committing suicide). Based on the above findings and suggestions, two major points are emphasized. First, the initiation of psychosocial open questions may be more appropriate in the family history stage during medical interviews. Second, the use of psychosocial open questions for ‘life changes’ may help doctors elicit more detailed information from patient parties. The implications of the present study are beneficial for medical educators, professionals, or doctors seeking to better probe patients’ psychosocial problems during medical interviews.
|Date of Award||2012|
|Supervisor||Mei-Hui Tsai (Supervisor)|