[Influence of changes in physicians' patterns of explanation on patients' compliance]

Although compliance of patients with their physicians' recommendations is necessary for effective treatment of most illnesses, compliance rates in general are low. Physicians usually behave according to the traditional dominance model of the professional-client relationship; they do not encourage their patients to participate, and give little or no explanations of illnesses or of the the treatment process. Interactions between 22 physicians and 139 patients who were on short-term treatment for acute infections were recorded and analyzed according to a method developed to assess form and content of participatory versus dominant modes of explanation. The relation of these data to patients' compliance, expectations and responses to explanations was investigated. After a short workshop in which the physicians learned to use the participatory explanation pattern, the process was repeated for 148 new interactions. As a control, responses of 142 other patients of the same physicians, whose interactions were not recorded so as to examine the influence of the recording itself, were also analyzed. It was found that most physicians used the dominant mode of explanation. However, participation in the workshop program changed in a significant way their explanatory patterns in the direction of more participatory ones. The majority of patients preferred the participatory type of explanation. The main finding was that the more participatory the explanation, the greater the patients' compliance, knowledge and satisfaction with the explanation.