Dialogues in the exam room: medical interviewing by resident family physicians

Limited information exists about the application of the biopsychosocial model in medical practice. This study expanded our knowledge about the extent to which psychosocial content is included in medical interviews conducted by resident family physicians.

Interviews of 180 patients conducted by six second-year family practice residents were audiotaped and transcribed. Physician statements were analyzed and coded as social talk, physician-centered statements, patient-centered statements, and discussion of patient affect, family, health promotion, and patient education.

The proportion of interviews in which specific physician interactions occurred were physician-centered statements: 100%, patient-centered statements: 66%, dealing with patient affect: 18%, information about family: 61%, initiation of health promotion: 33%, and initiation of patient education: 46%. Discussions of patient opinion/perception, patient affect, family information, and health promotion occurred most commonly during well-care visits and with female patients.

In this sample of residents, providers extended the interview beyond a purely biomedical focus. However, the psychosocial focus often was brief and applied inconsistently across patients.