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Clinical Decisionmaking

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Skill in communicating with patients is particularly important for surgeons

Communication during routine visits between patients and surgeons focuses on biomedical issues, with the largest portion of time devoted to discussions about patients' medical conditions and treatment options. In fact, almost half the visits are dedicated to patient education and counseling by surgeons, whose patients are typically referred to them for surgery. Hence, their job is to discuss the medical condition, explain treatment options, including a possible surgical procedure, and to help the patient understand the procedure in detail. The focus on patient education is strikingly different from the emphasis on medical history and physical examination typical of primary care visits, according to a study supported in part by the Agency for Health Care Policy and Research (HS07289).

Thus, it seems particularly important for surgeons to develop skills that enhance patient education and counseling, conclude Wendy Levinson, M.D., and Nigel Chaumeton, Ph.D., of the University of Chicago. They analyzed the structure and content of audiotaped routine office visits with 29 general surgeons and 37 orthopedic surgeons in urban community practice. They also examined post-visit questionnaires about visit content that were filled out by the surgeons and their patients.

Patients spent a mean of 13 minutes with the surgeon for surgical consultation. The typical visit consisted of an opening, medical history, physical examination, patient education/counseling, and closure. Surgeons usually asked closed-ended questions about specific medical and therapy issues, with these issues comprising 90 percent of visit content. Patient education and counseling lasted a mean of 5.5 minutes, accounting for almost half the average visit length. However, these visits did not place much emphasis on the psychosocial or emotional concerns of patients (only 1.3 percent of dialog), which if added to the discussion could enhance patient satisfaction, note the authors.

See "Communication between surgeons and patients in routine office visits," by Drs. Levinson and Chaumeton, in the February 1999 Surgery 125, pp. 127-134.

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