Physician practice styles and patient outcomes: differences between family practice and general internal medicine

Med Care. 1998 Jun;36(6):879-91. doi: 10.1097/00005650-199806000-00011.


Objectives: This study compared patient health status, patient satisfaction, and physician practice style between family practice and internal medicine.

Methods: New adult patients (n = 509) were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for 1 year of care. Practice styles were characterized by the Davis Observation Code. Self-reported health status (Medical Outcomes Study, Short Form-36) and patient satisfaction also were measured.

Results: There were no significantly different changes in self-reported health status or patient satisfaction between family practice and internal medicine physicians during the course of the study. Family practice initial encounters, however, were characterized by a style placing greater relative emphasis on health behavior and counseling, whereas internists used a more technical style. Improved health status scores after treatment were predicted by a practice style emphasis on counseling, whereas improvements in patient satisfaction scores were predicted by a style of care stressing patient activation. Although this is the first known randomized trial studying this issue, the conclusions are limited by a 38% loss of patients from enrollment to care and a loss of 18% at the 1-year follow-up evaluation.

Conclusions: There were significant differences in practice styles between family physicians and internists; however, it was the physician's behavior, not specialty per se, that affected patient outcomes. A practice style emphasizing psychosocial aspects of care was predictive of improvements in patient health status, whereas a practice style emphasizing patient activation was predictive of improvements in patient satisfaction.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • California
  • Counseling
  • Family Practice / standards*
  • Female
  • Health Services Research
  • Health Status
  • Hospitals, University
  • Humans
  • Internal Medicine / standards*
  • Male
  • Middle Aged
  • Outpatient Clinics, Hospital / standards*
  • Patient Participation
  • Patient Satisfaction
  • Physician-Patient Relations
  • Practice Patterns, Physicians' / standards*
  • Prospective Studies
  • Surveys and Questionnaires
  • Treatment Outcome*