Partnership, i.e., the physician's alliance with the patient, is part of any patient-centered interaction. Physicians' use of the first person plural to refer to themselves in alliance with the patient may be one way in which partnership is fostered. However, a new study reveals that physicians' use of "we" does not necessarily foster patient-physician partnership. The researchers analyzed audio recordings of encounters between 45 providers and 418 patients with HIV.
Contrary to the researchers' initial hypothesis, patients were less likely to rate their provider's communication style positively if the physician used "we" statements, but these statements did not affect patient ratings of provider's participatory decisionmaking style or their overall satisfaction. In 92 of 418 encounters, providers made 157 "we" statements. Factors associated with the use of "we" statements were younger patient age, higher patient depression scores, not being on antiretroviral therapy, and older provider age.
Each of the 157 statements was coded for both positive and negative characteristics. "We" statements considered to foster partnership included those that involved the patient in the health care process, addressed patient goals, created an understanding between doctor and patient, or contained reflections and/or discussion of a shared past. Features considered not to foster partnership involved persuasion, indirect communication, or ambiguous use. Of the 157 statements made by providers, 77 (49 percent) had at least one negative feature. When negative statements that seemed to be persuasive, indirect, patronizing, or condescending were used in the contexts of medication adherence, weight loss, smoking, and substance abuse, the use of the word "we" falsely involved the provider in activities that are the practical responsibility of the patient. In contrast, positive statements that occurred in the context of purposefully addressing the patient's goals, sharing medical decisionmaking, and legitimizing the patient-provider relationship seemed to contribute to a sense of equality between the two parties. This study was supported in part by the Agency for Healthcare Research and Quality (Contract No. 290-01-0012).
See "'We'll do this together': The role of the first person plural in fostering partnership in patient-physician relationships," by Helen Kinsman, B.S., Debra Roter, Dr.P.H., Gail Berkenblit, M.D., Ph.D., and others in the December 2009 Journal of General Internal Medicine 25(3), pp. 1178-1183.