Physician Practice Styles and Patient Outcomes: Differences between Family Practice and General Internal Medicine

Klea D Bertakis, Edward J Callahan, L. Jay Helms, Rahman Azari, John A. Bobbins, Jill Miller

Research output: Contribution to journalArticlepeer-review

98 Scopus citations

Abstract

OBJECTIVES. This study compared patient health status, patient satisfaction, and physician practice style between family practice and internal medicine. METHODS. New adult patients (n = 509) were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for 1 year of care. Practice styles were characterized by the Davis Observation Code. Self- reported health status (Medical Outcomes Study, Short Form-36) and patient satisfaction also were measured. RESULTS. There were no significantly different changes in self-reported health status or patient satisfaction between family practice and internal medicine physicians during the course of the study. Family practice initial encounters, however, were characterized by a style placing greater relative emphasis on health behavior and counseling, whereas internists used a more technical style. Improved health status scores after treatment were predicted by a practice style emphasis on counseling, whereas improvements in patient satisfaction scores were predicted by a style of care stressing patient activation. Although this is the first known randomized trial studying this issue, the conclusions are limited by a 38% loss of patients from enrollment to care and a loss of 18% at the 1-year follow-up evaluation. CONCLUSIONS. There were significant differences in practice styles between family physicians and internists; however, it was the physician's behavior, not specialty per se, that affected patient outcomes. A practice style emphasizing psychosocial aspects of care was predictive of improvements in patient health status, whereas a practice style emphasizing patient activation was predictive of improvements in patient satisfaction.

Original languageEnglish (US)
Pages (from-to)879-891
Number of pages13
JournalMedical Care
Volume36
Issue number6
StatePublished - Jun 1998

Keywords

  • Interactional analysis
  • Patient health outcomes
  • Patient satisfaction
  • Physician practice style
  • Physician-patient relationship

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

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