Special Issue: Doctor-patient Communication
Doctor-patient communication barrier is one of the major causes leading to medical disputes. Still, there are limited studies and rare instruments with good reliability and validity regarding doctors' ability to communicate with patients in China.
To construct the Five Habits Coding Scale (5HCS) and verify its reliability and validity.
The first draft of the Five Habits Coding Scale (5HCS) was formulated based on the Chinese version of the Four Habits Coding Scheme (4HCS) developed using Brislin's translation model in March 2014. Then from April to June 2014, the items of the first draft of 5HCS were revised in accordance with the expert consensuses obtained from two rounds of Delphi consultations, and after that, the final version of the 5HCS was developed, and utilized to evaluate 127 residents' abilities to communicate with patients in March 2018 for testing its internal consistency, inter-rater reliability, content validity and criterion-related validity.
The final version of 5HCS consists of 21 items fell under 5 dimensions, namely "Show respect and kindness, harmonize doctor-patient relationship" "Provide information, guide patients' views" "Demonstrate empathy, build up trust" "Risk disclosure, informed consent", and "Provide diagnostic information, shared-decision making". The Cronbach's α of the scale was 0.716. The dimension-total correlation coefficients (Pearson correlation coefficients) ranged from 0.524 to 0.692, and the content validity index of each item (I-CVI) ≥0.81. The inter-rater reliability was calculated by intraclass correlation (ICC) (Pearson coefficient=0.912, ICC=0.912, P<0.01) . And the criterion-related validity was testified by comparing to the Chinese version of SEGUE (r=0.377, P<0.01) .
The 5HCS has been proved to be highly reliable and valid, so it could be applied and promoted as a tool to evaluate the doctor-patient communication ability of residents in China.
Physicians' Perspective on Shared Decision-making：a Qualitative Study
Shared decision-making has promoted the transformation of the role of patients from passive recipients of health care to active participants and supervisors, deeply reflecting the idea of patient-centered care. Research on shared decision-making in China is still in its infancy. Physicians are major participants in decision-making, but their perspectives on shared decision-making have been rarely studied.
To explore physicians' perspective on shared decision-making, offering evidence for the implementation of shared decision-making.
From May to July 2020, we conducted semi-structured interviews with 15 physicians selected by convenience sampling method from a grade A tertiary hospital in Shanghai for investigating their actual decision-making process, their views and attitudes about shared decision-making, and the obstacles to clinical implementation of shared decision-making. The interview results were analyzed by Colaizzi's method of data analysis.
Among the 15 physicians, 10 were male and 5 were female; aged 28-53 years old, with an average age of (38.4±7.0) years old; 4 residents, 5 attending physicians, 4 associate chief physicians, and 2 chief physicians; 5 physicians, 7 surgeons and 3 oncologists. Four themes including 15 subthemes were identified: differences in physicians thederstanding of policies related to shared decision-making; unclear understanding of physicians and patients' roles in shared decision-making; acknowledging the importance of shared decision-making; obstacles to clinical implementation of shared decision-making.
Our study suggests that improving physicians' understanding level of shared decision-making, and creating conditions facilitating clinical implementation of shared decision-making may promote the sound development of shared decision-making.
Graduate supervisors in general practice are responsible for the important task of training future general practice professionals, so their abilities to communicate with patients are essential for the development of general practice.
To examine the abilities to communicate with patients in supervisors of master's students in general practice during outpatient encounters.
Seventy-five supervisors of master's students in general practice from Capital Medical University were selected by use of cluster sampling to receive a survey using a self-developed demographic questionnaire conducted from April to June 2022. Then their doctor-patient communication skills during outpatient encounters were assessed by relevant professionals who participated in the whole encounter process as accompaniers using the SEGUE Framework. The total score and dimension scores of SEGUE Framework of these supervisors were compared with those of outpatient specialists in tertiary hospitals and general practitioners (GPs) in community health centers (CHCs) in our previous studies, and were compared across these supervisors by sex, employment method and level of medical institutions. Then the total score of SEGUE Framework was compared between the supervisors and US GPs.
The total score of SEGUE Framework attained by the supervisors ranged from 12 to 24 points, and the average score was (17.8±2.6) . The average scores of five dimensions (set the stage, elicit information, give information, understand the patient's perspective, and end the encounter) obtained by them were (3.9±0.9) , (6.5±1.7) , (3.1±1.1) , (2.6±0.9) and (1.7±0.5) , respectively. These supervisors scored higher on dimensions of set the stage and end the encounter than GPs in CHCs and outpatient specialists in tertiary hospitals (P<0.05) . Compared with their counterparts working in primary hospitals, supervisors working in secondary hospitals scored lower on the SEGUE Framework and set the stage dimension (P<0.05) , and those working in tertiary hospitals scored lower on the SEGUE Framework and set the stage and elicit information dimensions (P<0.05) . These supervisor scored lower on the SEGUE Framework than the US GPs (P<0.05) .
There is still considerable room for improvement of the skills for communicating with patients in outpatient encounters in these supervisors. Their level of communication skills was still lower than that of US GPs. In view of this, the teaching management department responsible for general practice department (school) should pay attention to the training of the abilities of master supervisors to communicate with patients, thereby improving the level of medical humanities in practice in master's students in general practice by supervisors' words and deeds.
General practitioners (GPs) play an important role in diabetes care in primary care as the "gatekeepers" of population health. The management of diabetes can slow its progression, reduce complications and improve patient outcomes, which requires effective communication and collaboration between patients and their doctors. GPs with good communication skills can help to build long-term care relationships with diabetes patients and help them develop effective self-management skills. This paper summarizes the design and development of diabetes communication skills training for GPs guided by research team with multiple theoretical frameworks, including evidence-based findings from systematic review, experiences and ideas of diabetes patients communicating with GPs based on qualitative studies, prioritization of training content for patient-doctor communication in GPs captured by mixed-methods research, in order to provide new ideas for high-quality diabetes management in primary care and inform the design of training programmes for GPs based on evidence and medical education frameworks.
Shared decision-making is a practice that fully reflects the idea of patient-centered care, but its clinical implementation process is not ideal. Physicians are main participants to promote the implementation of shared decision-making, but there are few studies on their behaviors in shared decision-making.
To explore the process and main behavioral characteristics of physicians' participation in shared decision-making, offering evidence for the promotion and implementation of shared decision-making in clinical practice.
A mixed-methods convergent design was used to collect quantitative and qualitative data. In the quantitative study, convenience sampling method was used to select in-service physicians (n=360) from a grade A tertiary hospital in Shanghai to attend a questionnaire survey from May to December 2020 to understand the status of their participation in shared decision-making. K-means clustering was conducted to analyze the distribution characteristics of physicians' participation in shared decision-making. In the qualitative study, 23 physicians selected from the participants of the quantitative study using convenience sampling and purposive sampling from June to December 2020 were recruited to attend semi-structured interviews to explore the process and experience of their participation in shared decision-making and identify the main behavioral characteristics of them in each part of the process of shared decision-making.
Quantitative data analysis: in all, 325 (90.3%) of the physicians who returned responsive questionaries were included for analysis. The average total score of their participation behavior in shared decision-making was (80.44±14.88) . The further analysis found that physicians had the highest participation in behaviors of "Explain the advantages and disadvantages of the treatment options to my patient" (4.38±0.74) and "I told my patient that there are different options for treating his/her medical condition" (4.30±0.84) ; physicians had the lowest participation in behaviors of "I made clear to my patient that a shared decision needs to be made" (3.72±1.22) and "My patient and I selected a treatment option together" (3.74±1.03) . The results of cluster analysis showed that the behavioral characteristics of physicians' participation in shared decision-making could be divided into three groups, namely informed consent group, partial patient participation group and shared decision-making group. Qualitative data analysis: physicians' participation behaviors in shared decision-making included building up the awareness of shared decision-making, providing the patient with information, examining patient comprehension of the information, clarifying patient values, co-assessment (of the feasibility of the options) , reaching a decision and decision implementation. Analysis of the mixed-methods research results showed that in the decision-making process, physicians paid more attention to the provision of information, and ignored the behavioral factors of promoting patient participation at the level of doctor-patient communication. The behavioral characteristics of physicians' participation in shared decision-making were different.
The physicians' participation behavior in shared decision-making was limited. And they may have misunderstandings about the behavior process of shared decision-making. To promote the practical implementation of shared decision-making in clinical practice, it is suggested to help physicians clarify the process of shared decision-making via interventions enhancing their knowledge and attitudes regarding shared decision-making, deepen their understanding of shared decision-making through scenario simulation and role-playing, and improve their recognition of patient values in decision-making.
Under the background of new medical science, the deep integration of information technology and medical education is encouraged to train first-class medical talents to serve the construction of healthy China.Currently, empathy training in doctor-patient communication mainly consists of simulated communication and group discussion, with less reliance on artificial intelligence technology for learning.
To develop a system for teaching and evaluating doctor-patient communication empathy language. This system will be used in course teaching to pave the way for future doctor-patient communication empathy teaching methods. Carry out teaching applications to enhance the communication and empathy language expression skills of medical students and doctors, and gather feedback to optimize and improve the system.
Between September 2021 and February 2022, the research group focus on utilizing iFlytek speech recognition technology and the empathy semantic recognition algorithm. A system called the "Doctor-patient Communication Virtual Simulation Teaching and Evaluation System of empathic language" was developed using 10 typical cases of doctor-patient communication, demonstrations of empathic language, a semantic database of empathic language, empathic language skills, and an overall scoring standard.A total of 950 students from Nanjing Medical University, including 515 undergraduates, 102 medical doctoral students, and 333 clinicians participating in doctor-patient communication courses or training, were selected as the research subjects from March to May 2022. Based on this system, the Doctor-patient Communication Skills Course (2 class hours) teaching experiment was conducted at Nanjing Medical University. A self-designed questionnaire was used to gather information on the subjects' understanding of empathetic language connotations, their improved empathetic language skills, their perception of system ease of use, and their perception of how the system integrates into the rationality of teaching. NVivo software was used to analyze the subjects' feedback, comments, and suggestions.
Following the implementation of the system, there were statistically significant differences in the mastery of empathic language connotation, the degree of enhancement of empathic language ability, the degree of convenience of the system, and the degree of integration of the system into teaching rationality among undergraduate students, clinicians, and medical doctoral students (P<0.05). 76.1% (723/950) of the participants evaluated that they had "fully mastered" or "highly mastered" the connotation of empathic language. 93.8% (891/950) of the study subjects indicated that the system could "significantly enhance" or "somewhat enhance" the empathic language ability, and 89.5% (850/950) of the study subjects rated the convenience of the system as "very convenient" or "relatively convenient". 95.1% (903/950) of the study subjects rated the degree of cognition of the rationality of integrating the system into teaching as "very reasonable" or "relatively reasonable". The top five words mentioned in the feedback and suggestions are communication, pronunciation, teaching, program, and standard.
This system can help improve medical student and doctors'ability to empathize in doctor-patient communication by learning from individual cases and applying those lessons more broadly. Additionally, the use of an autonomous teaching evaluation system frees up the constraints of time and space in teacher-student interactions. The system's standardized teaching method has received positive and rational feedback from participants, indicating its potential for a wide range of applications. However, the system is still in the early stages of exploration and requires further refinement.
The concept of "patients-centered" has presented higher requirements doctor-patient communication and reconstructing doctor-patient relationship in public primary health care institutions.
To analyze the impact of "patients-centered" doctor-patient communication on the quality of primary care services, and provide scientific evidence to promote reforms in public primary health care institutions.
All public community health centers providing primary care services in the main urban area of a city in Inner Mongolia Autonomous Region were selected as the study sites to conduct a field survey in 2021 using the standardized patient method, which included 118 items of doctor-patient communication data involving 26 medical institutions, 59 doctors, and 12 standardized patients. Common cold, asthma, and unstable angina were selected as the types of diseases to be portrayed by the standardized patients in this study. A combination of multiple regression model and Probit model was used to evaluate the impact of "patients-centered" doctor-patient communication on the quality of primary care services.
Results obtained from the 118 items of doctor-patient communication data revealed that the median adherence rate for recommended consultation items was 17.6% (14.6%), and the median adherence rate for recommended examination items was 25.0% (40.0%), among them, 75 cases (63.6%) were correctly diagnosed, and 59 cases (50.0%) were correctly treated. The median total cost was 84.84 yuan (130.44 yuan), and the median drug cost was 37.62 yuan (47.38 yuan), among them, 66 (55.9%) involved unnecessary drugs, and 71 (60.2%) included unnecessary examinations. The median visit duration was 13.625 (10.850) min. The average score for "patients-centered" doctor-patient communication was (26.712±10.658), with the first dimension scoring (12.915±5.355) points, the second dimension scoring (7.492±2.867) points, and the third dimension scoring (6.305±3.465) points. The results of multiple linear regression model and Probit model indicated that for every one-point increase in the total score of patient-centered doctor-patient communication, the adherence rates for both recommended consultation items and recommended examinations items increased by 0.001 percentage points, the correct diagnosis rate increased by an average of 4.6 percentage points, the correct treatment rate increased by 4.2 percentage points, the total cost increased by 1.993 yuan, the drug cost increased by 0.517 yuan, the proportion of unnecessary drugs decreased by 3.4 percentage points, the proportion of unnecessary examinations increased by 0.2 percentage points, and the visit duration decreased by 0.291 minutes.
"Patients-centered" doctor-patient communication enhances the effectiveness and safety of medical services, while it also increases medical costs. It is necessary to promote "patients-centered" doctor-patient communication from the aspects of resource endowment, salary incentives, doctor-patient relationships, and collaborative services, thereby improving the quality of primary care services.
Enhancing doctor-patient trust is the key to improving medical service quality in the context of the general pracitce service system. This paper explores the doctor-patient trust in general practice services in depth based on doctor-patient trusted source model combining with literature analysis. It is concluded that the intensity of supervision of contracted services by the health administration, the facility environment of community health service institutions, the quality of services provided by general practitioners, and residents' own trust tendency are the key factors affecting the doctor-patient trust. From the perspective of the above four subjects, suggestions including strengthening the supervision of health administration, enhancing institutional trust, strengthening doctor-patient communication, enhancing interpersonal trust, and giving full play to residents' social supervision power are put forward in this paper, in order to improve the willingness to access primary health care services of residents and the quality of general practice services.
Doctor-patient communication is one of the core abilities of general practitioners. Dophisticated doctor-patient communication skills are the basis for building a harmonious doctor-patient relationship, and help to improve patients' sense of gain and satisfaction in seeking medical treatment. However, the communication ability of general practitioners in China is generally low, it is necessary to explore a training mode of doctor-patient communication that adapts to China's national conditions and meets the communication needs of general practitioners in China to improve the communication ability between doctors and patients.
To explore the application effect of salon training based on the Calgary-Cambridge Guide in the training of doctor-patient communication ability of resident doctors in standardized training of general practitioners, and to provide reference for the construction of doctor-patient communication training system.
Forty cases of general practitioners in Chengdu Fifth People's Hospital Standardized general practice training from 2019 to 2020 were selected as the research object, and randomly divided into salon group and control group, with 20 cases in each group. Salon group used salon training mode based on Calgary-Cambridge guidelines for doctor-patient communication training, while the control group was set as blank control. Before the training and one week after the training, the standardized patient (SP) model was adopted to clinical reception in the two groups, and the doctor-patient communication evaluation scale (SEGUE) was used to evaluate the level of doctor-patient communication, and the training effects of the two groups were compared.
Finally, 28 cases were included, including 15 cases in the salon group and 13 cases in the control group. After the training, the score of the SEGUE scale of the training doctors in the salon group increased from (11.80±4.36) to (18.07±4.11), and that of the training doctors in the control group increased from (12.15±4.63) to (14.46±3.71). The score of SEGUE scale in Sharon group after training was significantly different from that before training (t=3.250, P< 0.001). There was no significant difference in the score of SEGUE scale between the control group after training and before training (t=2.582, P=0.624). After training, 25 items in the SEGUE scale were analyzed, and the difference between the salon group and the control group was statistically significant (P<0.05). The results of the following five items in the salon group were better than those in the control group: "Establishing personal trust relationship" (93.3% vs. 7.7%) and "Protecting patients' privacy/respecting patients' right to choose" (53.3% vs. 15.4%) in the preparation stage; Understand the patient's stage of "recognizing the patient's efforts, changes and difficulties" (33.3% vs. 23.1%) and "expressing concern and making the patient feel warm/confident" (100.0% vs. 69.2%) ; At the end of the consultation stage, "Ask the patient if there are any other questions to discuss" (66.7% vs. 23.1%) .
Salon training mode based on Calgary-Cambridge guidelines can enhance students' interest and enthusiasm in participating in the training, which has a good training effect on improving the communication ability between doctors and patients, and is worth learning and popularizing.
Psychosomatic disorders present high prevalence and disease burden in the community. Currently, different disciplines of medical institutions possess unclear functions and inadequate process strategies for the diagnosis and treatment of psychosomatic disorders, resulting in differences in the perceptions of disease and behavioral characteristics of doctors and patients, which affects the management of disease in the community.
To understand and analyze the cognitive and behavioral characteristics as well as the influencing factors of psychosomatic disorders from multiple perspectives of doctors and patients, and then provide strategic directions to improve the diagnosis and management of psychosomatic patients in the community.
During the period from 2022-02-01 to 06-31, 5 internists from a general hospital (H1) in Yangpu District, 12 general practitioners from 2 community health centers (H2, H3) in Yangpu District, and 2 community health centers (H4, H5) in Jiading and Pudong New Districts, 2 healthcare professionals from a mental health center hospital in Yangpu District, and 10 patients and with psychosomatic disorders who had been treated in the above hospitals or their relatives. The interview was performed by WeChat, face-to-face as well as telephone and other methods, with the content including perceptions of psychosomatic disorders, healthcare seeking behaviors, disease attitudes, problems and suggestions, and lasted 15-30 min. The interview content was recorded and transcribed into text, coded, summarized to generate themes, and finally quoted from representative interviewees.
(1) There was a high level of disease awareness among general practitioners and psychiatrists, a low level of awareness among internists, and a general lack of awareness among patients. (2) General practitioners and psychiatrists possessed more experience in the diagnosis and treatment of psychosomatic disorders, but lacking sufficient work and effective treatment results. (3) The attitudes of multiple doctors and patients were varied with an overall lack of positivity. General practitioners had the most positive attitudes toward the diagnosis and treatment of psychosomatic disorders. (4) Doctors of different disciplines faced difficulties, including large patient bases, insufficient mental health resources, lack of solid psychological perceptions, lack of standardized guidelines for diagnosis and treatment, and busy practices, etc. (5) Most patients had not received psychotherapy, but they didn't exclude it either, while there were problems such as distrust of general practitioners, fear of treatment side effects, and health seeking behavior affected by many factors. (6) Both doctors and patients offered constructive suggestions, which included strengthening publicity and policy guidance to the public, promoting the continuous development of psychosomatic medicine, improving doctors' identification of psychological disorders, opening joint clinic for chronic disease and psychology, improving the experience of medical treatment, setting up a comfortable treatment environment, and coordinating referrals, etc.
Barriers such as differences in perceptions and attitudes between doctors and patients, unequal medical resources, and irregularities in behavior exist between doctors and patients. In the community, it is necessary to strengthen the advantages and functions of general practitioners on the management of psychosomatic disorders; fully implement and utilize relevant resources; and improve the negative attitudes of both doctors and patients, so that patients can seek proper medical treatment and improve their mental health.
Menopausal hormone therapy (MHT) can effectively relieve menopausal symptoms, but its treatment options are diverse, and it is essential to make treatment decisions meeting women's needs. However, the current investigation on the quality of shared decision making between doctors and patients (SDM) in menopausal hormone therapy needs to be supplemented.
To analyze the quality of SDM in MHT among menopausal syndrome patients and explore its influencing factors, so as to provide a theoretical basis for achieving quality clinical care for menopausal population.
A total of 101 patients with menopausal syndrome from Center for Gynecological Endocrinology and Reproduction in Peking Union Medical College Hospital from October 2022 to January 2023 were selected as study subjects. The study was conducted using the questionnaire method, which consisted of general demographic information, treatment-related information and SDM quality survey. The Chinese version of 9-items shared decision making questionnaire (SDM-Q-9) was used to assess the SDM quality of patients. Multiple linear regression analysis was used to explore the influencing factors of SDM quality in MHT among patients with menopausal syndrome. Multiple linear regression analysis was used to explore the influencing factors of the quality of SDM in MHT among patients with menopausal syndrome.
The average score of SDM quality was 89.75. Patients with children, considered MHT to be very effective, with symptoms of hot flushes and sweating, insomnia and mood fluctuations, advised by doctors to receive MHT had better degree of participation in SDM (P<0.05). Multiple linear regression analysis showed that patients with children (β=0.26, P=0.005), hot flushes and sweating (β=0.19, P=0.044), insomnia (β=0.23, P=0.017) and recommendation by doctors (β=0.21, P=0.025) are influencing factors of SDM quality in MHT of patients with menopausal syndrome, which could explain 23.7% of the variation in SDM quality.
SDM quality is relatively good in MHT among menopausal syndrome patients. Patients with children, hot flashes and sweating, insomnia, and recommendation for use by doctors are influencing factors of SDM quality in MHT among menopausal syndrome patients. Doctors should take the initiative to include patients in SDM, so that patients can realize that they are the principal leader of their health and make SDM consistent with their needs and values in conjunction with doctors.
The phase of undergraduate medical education is the starting point for fostering communication competence of students in Rural-oriented Free Tuition Medical Education Program (RTME), which lays the foundation both for communication competence training in the postgraduate education phase and performing effective communications with patients and their relatives, colleagues, and other health personnel in the career life of general practitioners (GPs). It is of great practical significance to explore how to improve quality of doctor-patient communication education in the stage of undergraduate medical education and develop doctor-patient communication competence of the RTME students.
To explore the role of the ladderlike communication skill course on fostering doctor-patient communication competence of students in rural-oriented free tuition medical education program.
A total of 259 RTME students of Grade 2019 were selected from Guangxi Medical University in September 2019 to establish Cohort 1, and 262 undergraduate medical students of Grade 2019 were selected to establish Cohort 2. From September 2019 to January 2022, the students in Cohort 1 were trained in a ladderlike communication skill course lasting for five consecutive semesters; from September 2021 to January 2022, the students in both cohorts were trained in a doctor-patient communication course. The final exam scores and process assessment scores of the two cohorts on the doctor-patient communication course were compared and the evaluation of teaching effectiveness and satisfaction of ladderlike communication skill course were investigated in the students in Cohort 1.
The RTME students achieved significantly greater total scores for the final exam of the doctor-patient communication course, in which the RTME students performed better on the sections of case analysis and small essay, but worse on the single-choice question section compared to the undergraduate medical students (P<0.05). Similarly, the RTME students obtained higher scores on the process assessment of the doctor-patient communication course than undergraduate medical students, resulting from higher scores on the dimensions of information collection, information giving, negotiation and resolution, and nonverbal communication skills (P<0.05), and there was no statistically significant difference in the scores on the dimension of establishing first impression (P>0.05). Over 80% of RTME students felt satisfied or absolutely satisfied with the content, pedagogical measures, faculty, schedule and effects of the ladderlike communication skill course, and more than 60% believed it helped or absolutely helped promote learning interest, increase confidence to encounter difficult patients, and raise multiple competence, including empathy, doctor-patient communication, language expression, problem resolution, and team work.
The ladderlike communication skill course significantly elevates the effects of doctor-patient communication education in the phase of undergraduate medical education for the RTME students, facilitates the development of doctor-patient communication competence and other comprehensive competence. The ladderlike course mode is an effective measure fostering doctor-patient communication competence of medical students in medical education, and makes a useful reference for communication competence training for postgraduate education and continuing education of general practice.
The doctor-patient relationship is the focus of attention in the medical field. General practice clinic is an important place for providing continuous and comprehensive medical services, and the communication ability of general practitioners (GPs) is particularly important for improving the doctor-patient relationship. However, there are few studies on the current situation of doctor-patient communication in general practice clinic in China.
To understand the characteristics and current situation of doctor-patient conversation in general practice clinic, in order to provide empirical support for improving communication skills of GPs, optimizing doctor-patient communication strategies, and building a harmonious doctor-patient relationship.
Convenience sampling method was used to select eight GPs from one tertiary hospital and three community health service centers (stations). Natural observation method was used to collect 100 doctor-patient conversation corpus from May to August 2024. The Roter Interaction Analysis System (RIAS) was used to classify, code and quantify the doctor-patient conversation, describe the topic structure of the conversation, and analyze the discourse differences.
A total of 18 667 doctor-patient utterances were collected; 8 784 from doctors and 9 883 from patients.The verbal dominance ratio was 0.89, the patient-centeredness score was 1.27, and the psycho-biomedical ratio was 0.10 in the general practice clinic. The three most frequent topics of physician discourse were biomedical information giving (28.78%), active dialogue (25.18%) and biomedical information seeking (13.79%), while the three most frequent topics of patient discourse were biomedical information giving (34.68%), active dialogue (28.45%) and social language (14.82%). GPs were more likely to ask for biomedical information (P=0.001) and psycho-social information (P=0.003) than patients, but less likely to give biomedical information (P<0.05) and psycho-social information (P<0.001) than patients. Patients had more social language than doctors (P=0.003). The verbal dominance ratio, biomedical information seeking, biomedical information giving, biomedical advice and guidance, and step language of GPs in tertiary hospitals were higher than those in community GPs (P<0.05), while the psycho-biomedical ratio, psycho-social advice and guidance, and social language of GPs in tertiary hospitals were lower than those in community GPs (P<0.05). The frequency of biomedical information seeking, biomedical information giving and positive dialogue of GP-patient in the tertiary hospitals were higher than those in the community GP-patient (P<0.05), while the social language of GP-patient in the community was significantly higher than that in the tertiary hospitals (P<0.01) .
The patient occupies a dominant position in the discourse of the doctor-patient conversation in the general practice clinic. The theme of the doctor-patient conversation is mainly biomedical, and the degree of "patient-centered" is relatively good. Compared with patients, general practitioners had more "seeking discourses" and less "giving discourses". Compared with the GPs in the community, the GPs in the tertiary hospitals have a higher proportion of language dominance, more biomedical discourse, and less psycho-social discourse. GPs should pay more attention to patients' emotional needs, information acquisition needs and psycho-social factors of the disease, so as to improve doctor-patient communication skills and medical service quality.
More and more attention has been paid to the training of medical students' doctor-patient communication skills. It was necessary to improve the doctor-patient communication skills of general medicine postgraduates.
To explore the current situation of doctor-patient communication ability of postgraduates in general medicine and the influence of mentors on it.
A total of 72 full-time postgraduate students majoring in general practice, who were being supervised by 66 full-time postgraduate supervisors from the School of General Practice and Continuing Education of Capital Medical University from January to December 2023, were selected as the research subjects. The doctor-patient communication skills of the postgraduate students and their supervisors were evaluated using the SEGUE scale, and evaluate the gap between them and Beijing general practitioners and outpatient doctors in tertiary hospitals; the correlation analysis between the communication ability of the supervisors and the students in Pearson.
The professional master's degree students majoring in general practice scored lower than Beijing general practitioners in the dimensions of preparation, information collection, information provision, understanding patients, ending the consultation and the total score (P<0.05), and scored lower than the general practitioners in the tertiary grade A hospitals in Beijing in the dimensions of information collection, information provision, ending the consultation and the total score (P<0.05). According to whether the main clinical training unit is the supervisor group, the graduate students are divided into the accompanying supervisor group and the not accompanying tutor group. The preparation stage, information collection dimension score and total score of the accompanying tutor group were higher than the unrelated tutor group (P<0.05). With the supervisor group, the preparation stage, information collection, information giving, patient understanding, end of the SEGUE scale and the total score were positively correlated (P<0.05). A positive correlation was observed between the graduate students and the supervisor SEGUE scale in the supervisor group (P<0.05) .
The doctor-patient communication skills of general medicine postgraduates need to be further improved. The doctor-patient communication skills of postgraduates were closely related to their tutors. Appropriate optimization of the training mode of general medicine postgraduates should help to improve the doctor-patient communication skills of general medicine postgraduates.
Special Issue: Doctor-patient Communication
