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ARTICLE |

Improving Physicians' Interviewing Skills and Reducing Patients' Emotional Distress:  A Randomized Clinical Trial

Debra L. Roter, DrPH; Judith A. Hall, PhD; David E. Kern, MD, MPH; L. Randol Barker, MD, ScM; Karan A. Cole, ScD; Robert P. Roca, MD
Arch Intern Med. 1995;155(17):1877-1884. doi:10.1001/archinte.1995.00430170071009.
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Background:  Despite high prevalence, emotional distress among primary care patients often goes unrecognized during routine medical encounters.

Objective:  To explore the effect of communication-skills training on the process and outcome of care associated with patients' emotional distress.

Methods:  A randomized, controlled field trial was conducted with 69 primary care physicians and 648 of their patients. Physicians were randomized to a no-training control group or one of two communication-skills training courses designed to help physicians address patients' emotional distress. The two training courses addressed communication through problem-defining skills or emotion-handling skills. All office visits of study physicians were audiotaped until five emotionally distressed and five nondistressed patients were enrolled based on patient response to the General Health Questionnaire. Physicians were also audiotaped interviewing a simulated patient to evaluate clinical proficiency. Telephone monitoring of distressed patients for utilization of medical services and General Health Questionnaire scores was conducted 2 weeks, 3 months, and 6 months after their audiotaped office visits.

Results:  Audiotape analysis of actual and simulated patients showed that trained physicians used significantly more problem-defining and emotion-handling skills than did untrained physicians, without increasing the length of the visit. Trained physicians also reported more psychosocial problems, engaged in more strategies for managing emotional problems with actual patients, and scored higher in clinical proficiency with simulated patients. Patients of trained physicians reported reduction in emotional distress for as long as 6 months.

Conclusions:  Important changes in physicians' communication skills were evident after an 8-hour program. The training improved the process and outcome of care without lengthening the visits.(Arch Intern Med. 1995;155:1877-1884)

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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