Characterizing patient requests and physician responses in office practice

Understanding how patients communicate their needs and how physicians respond is critical for improving clinical interactions. Prior research has shown that patient requests often influence the quality of care and physician workload. However, no prior work had resolved how to systematically categorize and measure these requests in real-world settings. This gap motivated the development of a refined system called TORP to classify patient requests and physician responses. Existing tools lacked the specificity to capture the full range of patient needs, especially in diverse clinical settings. The study aimed to address this limitation by testing TORP's reliability and validity. Earlier studies had focused on general communication patterns but not on quantifiable metrics of request fulfillment. This paper's contribution lies in applying a multidisciplinary approach to refine TORP and assess its practical use in office settings. The results offer insights into how patient requests vary with emotional states and clinical specialties.

The goal of this study was to evaluate the reliability and validity of the refined TORP system for tracking patient requests and physician responses in office visits. Researchers wanted to determine whether TORP could consistently categorize requests and whether it could predict clinical outcomes. The study focused on two specific practice settings: general internal medicine and cardiology. The motivation stemmed from the need to standardize how patient requests are recorded and analyzed across different medical specialties. The researchers aimed to test whether TORP could be used to measure variations in patient requests based on emotional states and physician specialties. The method involved analyzing audio recordings of patient visits and physician responses. The study also sought to explore how patient requests affect visit duration and physician perception of demand. This approach allowed for a more nuanced understanding of the patient-physician negotiation process.

The study collected data from 131 patient visits, including 71 in internal medicine and 60 in cardiology. Audio recordings of these visits were independently rated by two coders using the refined TORP system. The researchers calculated intercoder agreement for both unitizing and classification reliability. Unitizing reliability assessed agreement on identifying patient requests, while classification reliability measured agreement on categorizing those requests. Physicians and patients were surveyed before and after visits to gather additional data. A multidisciplinary panel contributed to refining TORP's structure and categories. The study tested three hypotheses about the antecedents and consequences of patient requests and their fulfillment. Researchers analyzed differences in request frequency between generalists and specialists. They also examined how patient worry levels correlated with request volume and visit characteristics.

The unitizing kappa for identifying patient requests was 0.64, and the classification kappa was 0.73, indicating substantial agreement beyond chance. On average, patients made 4.19 requests for information and 0.88 requests for physician action per visit. There were few differences in the types of requests between internal medicine and cardiology. About 15 percent of visits included a direct request for paperwork completion. Patients who were very or extremely worried made significantly more requests (6.06 vs. 3.89, p < 0.05). Visits with more patient requests lasted longer (p < 0.05) and were perceived as more demanding by physicians (p = 0.025). The majority of patient requests were fulfilled by physicians. These findings suggest that TORP is a reliable and valid tool for capturing patient requests in clinical settings. The system appears applicable across both generalist and specialist practices.

The study found that the refined TORP system demonstrates substantial reliability in identifying and categorizing patient requests. The results suggest that TORP can be a useful tool for analyzing clinical negotiations in office settings. The system's applicability was confirmed in both generalist and specialist practices. The authors propose that TORP can help track how patient requests influence physician workload and visit duration. They also suggest that the system could be used to explore the relationship between patient worry and request frequency. However, the authors caution that more experience with TORP is needed to assess its ability to predict important clinical outcomes. The findings support the continued refinement and use of TORP in future studies. The authors emphasize the importance of further validation in diverse clinical settings.