Paterniti D, Franz C, Kravitz R, Feldman M, Epstein R; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1937.
University of California, Davis, Internal Medicine, 2103 Stockton Boulevard, Suite 2224, Sacramento, CA 95817 Tel. 916.734.2367 Fax 916.734.2349
RESEARCH OBJECTIVE: The purpose of this study was to assess whether standardized patients (trained actors)can be trained to observe with an ethnographic eye the context and quality of physician visits. STUDY DESIGN: We undertook an ethnographic study of physician office visits using standardized patients (SPs) to provide an understanding of patient views of the context and quality of physician visits. SPs trained in specific roles were instructed on making ethnographic observations of all aspects of their visit. SPs were provided a literature-generated list of visit aspects they might consider as important to observation; however, SPs were instructed to reflect on all aspects of their visit and to describe those aspects that were most salient to them as patients. SPs dictated field notes immediately following each visit. Transcripts of the notes were reviewed for persistent and recurring themes related to SP perceptions of the context and quality of their visit and its effect on them as patient. POPULATION STUDIED: Twelve SPs scheduled and attended new patient visits with 52 different physicians at both fee-for-service and HMO practice settings. PRINCIPAL FINDINGS: Analysis of 58 field notes from office visits reveals the impact of the dual role of patient and actor on SP perspectives of the visit. SP perceptions of their role as actor impacted their patient perspectives on satisfaction with the visit and trust in physician recommendations for treatment (e.g., having the physician probe into SP occupational status or familiar relationships in town, delving too much into the "patient's" personal life). SPs were careful to note the behaviors they tried to avoid as actors that they believed might jeopardize their role as an authentic patient in their relationship with the physician (e.g., accepting a "dirty" thermometer, being younger than the average age of waiting room patients, reporting back pain and bending improperly in the waiting room). SPs also reported tolerating or accepting behaviors in the role of actor that they believed they would not accept as an authentic patient. CONCLUSIONS: Our findings reveal the potential impact of the dual role on the use of SPs as expert witnesses of the medical encounter. Potential conflict between the roles of patient actor and authentic patient may be a barrier to using SPs as ethnographic observers. Understanding such conflict, however, may be useful in designing more directive training for SPs who may have an opportunity to be an "expert witness." IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Standardized patients are increasingly used to assess quality of care in medical settings, as part of medical education, and in research. SPs have an advantage over patients in witnessing the delivery of care for the same condition with a variety of physicians and in various contexts. Yet, SPs must deal with the dual role of both patient and actor. The dual role of SP should be considered in assessment of SP reports of quality of care and in the training of standardized patients.
Publication Types:
Keywords:
- Health Services Research
- Humans
- Observation
- Physicians
- Physicians, Family
- Research
- Research Design
- Trust
- methods
- hsrmtgs
UI: 103624971
From Meeting Abstracts