Measuring patient and physician participation in exchanges on medications: Dialogue Ratio, Preponderance of Initiative, and Dialogical Roles

Patient Educ Couns. 2007 Mar;65(3):329-41. doi: 10.1016/j.pec.2006.08.014. Epub 2006 Nov 13.


Objective: To identify, describe and characterize the patient and physician participation in content production in medication-related exchanges during primary care consultations.

Methods: Descriptive study of audio recordings of 422 medical encounters. MEDICODE, a validated instrument was used to analyze verbal exchanges on medications. Two main indicators of participation were developed: Dialogue Ratio (DR), a 0-1 scale indicating extent of monologue/dialogue; Preponderance of Initiative (PI), a -1 to +1 scale for patient/physician initiative. Participation analyses were conducted by content theme and medication categories (New, Represcribed and Active).

Results: We identified 1492 discussions of medications. Categorical analyses identified four communication roles patients and physicians adopted when participating in medication-related exchanges during consultations: (a) Listener, (b) Information Provider, (c) Participant, and (d) Instigator. The mean observed DRs and PIs indicated that monologues and physician initiation dominated medication-related exchanges.

Conclusion: Four factors are suggested to explain the communicational behaviors observed: (1) patient knowledge about medications, (2) physician expertise, (3) patient experience with the medication, and (4) the act of prescribing. Our data indicate a generally low level of dialogue when discussing medications during primary care encounters since physicians' monologues seem to be the rule rather than the exception, pointing to a lack of mutuality in exchanges on medications.

Practice implications: The proposed concepts offer a unique vocabulary and conceptual framework to help physicians master the necessary content and process skills required to discuss medications with patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abstracting and Indexing / methods
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Assertiveness
  • Clinical Competence
  • Communication*
  • Data Collection / methods*
  • Drug Therapy / psychology*
  • Drug-Related Side Effects and Adverse Reactions
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Education as Topic / methods
  • Patient Education as Topic / statistics & numerical data
  • Patient Participation / methods
  • Patient Participation / psychology*
  • Patient Participation / statistics & numerical data
  • Physician's Role / psychology*
  • Physician-Patient Relations*
  • Primary Health Care / methods
  • Quebec
  • Surveys and Questionnaires
  • Tape Recording