TY - JOUR
T1 - Problems and processes in medical encounters
T2 - The cases method of dialogue analysis
AU - Laws, M. Barton
AU - Taubin, Tatiana
AU - Bezreh, Tanya
AU - Lee, Yoojin
AU - Beach, Mary Catherine
AU - Wilson, Ira B.
PY - 2013/5
Y1 - 2013/5
N2 - Objective: To develop methods to reliably capture structural and dynamic temporal features of clinical interactions. Methods: Observational study of 50 audio-recorded routine outpatient visits to HIV specialty clinics, using innovative analytic methods. The Comprehensive Analysis of the Structure of Encounters System (CASES) uses transcripts coded for speech acts, then imposes larger-scale structural elements: threads - the problems or issues addressed; and processes within threads - basic tasks of clinical care labeled Presentation, Information, Resolution (decision making) and Engagement (interpersonal exchange). Threads are also coded for the nature of resolution. Results: 61% of utterances are in presentation processes. Provider verbal dominance is greatest in information and resolution processes, which also contain a high proportion of provider directives. About half of threads result in no action or decision. Information flows predominantly from patient to provider in presentation processes, and from provider to patient in information processes. Engagement is rare. Conclusions: In this data, resolution is provider centered; more time for patient participation in resolution, or interpersonal engagement, would have to come from presentation.Practice implications: Awareness of the use of time in clinical encounters, and the interaction processes associated with various tasks, may help make clinical communication more efficient and effective.
AB - Objective: To develop methods to reliably capture structural and dynamic temporal features of clinical interactions. Methods: Observational study of 50 audio-recorded routine outpatient visits to HIV specialty clinics, using innovative analytic methods. The Comprehensive Analysis of the Structure of Encounters System (CASES) uses transcripts coded for speech acts, then imposes larger-scale structural elements: threads - the problems or issues addressed; and processes within threads - basic tasks of clinical care labeled Presentation, Information, Resolution (decision making) and Engagement (interpersonal exchange). Threads are also coded for the nature of resolution. Results: 61% of utterances are in presentation processes. Provider verbal dominance is greatest in information and resolution processes, which also contain a high proportion of provider directives. About half of threads result in no action or decision. Information flows predominantly from patient to provider in presentation processes, and from provider to patient in information processes. Engagement is rare. Conclusions: In this data, resolution is provider centered; more time for patient participation in resolution, or interpersonal engagement, would have to come from presentation.Practice implications: Awareness of the use of time in clinical encounters, and the interaction processes associated with various tasks, may help make clinical communication more efficient and effective.
KW - Clinical decision making
KW - HIV
KW - Outpatient care
KW - Physician-patient communication
UR - http://www.scopus.com/inward/record.url?scp=84875890373&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84875890373&partnerID=8YFLogxK
U2 - 10.1016/j.pec.2012.12.012
DO - 10.1016/j.pec.2012.12.012
M3 - Article
C2 - 23391684
AN - SCOPUS:84875890373
SN - 0738-3991
VL - 91
SP - 192
EP - 199
JO - Patient Education and Counseling
JF - Patient Education and Counseling
IS - 2
ER -