Levels of physician involvement with patients and their families. A model for teaching and research

J Fam Pract. 1994 Dec;39(6):535-44.


Background: We present an educational model that describes physician skills for addressing psychosocial concerns of patients, ranging from basic medical questions to in-depth psychotherapy. This model improves upon previously published models by integrating into one hierarchy levels of physician involvement with individual patients and levels of involvement with families.

Methods: Ten faculty family physicians were videotaped during 200 office visits. Interviews were categorized according to the model, with a 79% interrater agreement.

Results: Most visits involved the lower three levels of physician involvement (41%, level 1; 35.5%, level 2; and 23%, level 3). Discussion of family context occurred in a majority (58.5%) of visits, primarily when another family member was in the room and during preventive care visits. Higher levels were associated with longer visits--about 3 minutes more for each additional level.

Conclusions: This investigation suggests that the levels of physician involvement model can be reliably measured. This model may be a useful tool for education and research, particularly the study of physician interview skills appropriate to family medicine.

MeSH terms

  • Adult
  • Faculty, Medical
  • Family Practice* / education
  • Female
  • Humans
  • Internship and Residency
  • Male
  • Middle Aged
  • Midwestern United States
  • Models, Educational*
  • Office Visits* / statistics & numerical data
  • Patient Education as Topic
  • Physician-Patient Relations*
  • Physicians, Family* / education
  • Psychotherapy