Levels of physician involvement with patients and their families. A model for teaching and research

We present an educational model that describes physician skills for addressing psychosocial concerns of patients, ranging from basic medical questions to in-depth psychotherapy. This model improves upon previously published models by integrating into one hierarchy levels of physician involvement with individual patients and levels of involvement with families.

Ten faculty family physicians were videotaped during 200 office visits. Interviews were categorized according to the model, with a 79% interrater agreement.

Most visits involved the lower three levels of physician involvement (41%, level 1; 35.5%, level 2; and 23%, level 3). Discussion of family context occurred in a majority (58.5%) of visits, primarily when another family member was in the room and during preventive care visits. Higher levels were associated with longer visits--about 3 minutes more for each additional level.

This investigation suggests that the levels of physician involvement model can be reliably measured. This model may be a useful tool for education and research, particularly the study of physician interview skills appropriate to family medicine.