Patient Contribution to the Medical Dialogue and Perceived Patient‐Centeredness

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 safeguarded even in a short visit, when a companion is present.