Patient contribution to the medical dialogue and perceived patient-centeredness: An observational study in Japanese geriatric consultations

BACKGROUND: Relatively few studies have directly addressed the interaction dynamics and consequences of a companion's presence in the medical visit, and their findings have been contradictory. OBJECTIVES: To examine how patient's contribution to the medical dialogue, with or without the presence of a visit companion, is related to the perception of the medical visit as patient-centered. DESIGN: Observational study using pre- and postvisit questionnaires and audiotape recording of medical visits. PARTICIPANTS: One hundred and fifty-five patients aged 65 or over; 63 in medical visits that included the presence of a companion and 82 in visits that did not include a companion. MAIN OUTCOME MEASURE: Patient ratings of visit patient-centeredness. RESULTS: Long visits (greater than 10 minutes long) and visits in which patients were verbally active were rated as more patient-centered by patients than other visits. Since patients were generally less verbally active in visits that included a companion, accompanied visits, especially if they were less than 10 minutes long, received lower patient-centered ratings than others. The presence of a companion was not related to length of the visit, suggesting that the verbal activity of the companion was off-set by decreased verbal activity of the patient. CONCLUSIONS: Our results have suggested that patients are more likely to perceive their physician and visit as patient-centered when they have an opportunity to engage directly in the medical dialogue. A minimal amount of "talk-time" for patients themselves should be safe-guarded even in a short visit, when a companion is present.