"Chicken pot pie?" : a phenomenology of questions asked by patients during primary care visits

172 Pages·1997·6.1 MB·English

by  Walker, David Elliott

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YAIF HRRftRY
AUG 0 4 1997
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"CHICKEN POT PIE?":
A PHENOMENOLOGY OF QUESTIONS ASKED BY PATIENTS
DURING PRIMARY CARE VISHS
A Thesis Submitted to the
Yale University School of Medicine
in Partial Fulfillment of the Requirements for the
Degree of Doctor of Medicine
hf
David Elliott Walker
1997
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ABSTRACT
"CHICKEN POT PIE?": A PHENOMENOLOGY OE QUESTIONS ASKED BY
PATIENTS DURING PRIMARY CARE VISITS. David E. Walker (Sponsored
by Nicholas H. Eiebach). Department of Internal Medicine, Yale University,
School of Medicine, New Haven, CT.
There is increased interest in the effects of improved communication
in the doctor-patient relationship. In their interventions to encourage
communication within the medical dialogue, investigators have focused
attention on patient questions as a key indicator of patient participation.
However, investigators have not sought to further characterize what patients
are asking. The author set out to do so, employing a qualitative approach to
develop a methodology. Two important and potentially useful descriptors of
patient questions were generated: question topics and question goals. The
methodology was then tested on a sample of encounters between primary
care patients and their providers. Patients were found to ask over 12
questions per encounter, 2 to 4 times the averages previously reported. Most
questions were about medications, the logistics of the visit, or personal or
interpersonal matters. Few questions were about health risks, prevention
and prognosis, and even fewer were about matters of diagnosis, disease
etiology and pathophysiology. Although most questions were asked to
further the patient's factual knowledge, many were intended to express or
appeal to emotions. The methodology and the findings are reviewed and
discussed, and a theory of patient participation in the doctor-patient
relationship is presented.