Perpetuating passivity: reliance and reciprocal determinism in physician-patient interaction

This study introduces, profiles, and tests the explanatory value of reliance, a construct that emerged from, and is expected to illuminate, consideration of perceived control in medical encounters. The investigation also links communication science with the truly interactive perspective of reciprocal determinism, highlighting the impact of personal relations and the significance of perceived control. Data from 271 encounters between general practitioners and patients in Oxford (England) were collected by means of videotapes, patient questionnaires, medical record reviews, and physician questionnaires. The analysis indicates that physician-reliant patients (i.e., those who rely on physicians to make decisions for them) tend to be older and from a more working-class background than were self-reliant patients (i.e., those more interested in participating in choices about their health care). The physician-reliant patients also had more externally oriented outcome expectations and tended to see physicians more often than did their self-reliant counterparts. In addition to defining reliance at the conceptual and operational levels, this study provides preliminary evidence that reciprocal determinism is operating in medical encounters: Despite their preference for patients who feel in control of their health, physicians tended to adapt to patients' reliance orientation, sharing decisions with self-reliant patients and making decisions for physician-reliant patients. Accommodating the passive orientation of physician-reliant patients is likely to diminish patients' chances for maintaining control in the medical encounter, which has implications for health outcomes, cost, and compliance.