Patient Education and Counseling 57 (2005) 22–29 Changes in physician–patient communication from initial to return visits: a prospective study in a haematology outpatient clinic Peter Kjær Graugaard * , Kjersti Holgersen, Hilde Eide, Arnstein Finset Department of Behavioral Sciences in Medicine, University of Oslo, P.O. Box 1111, Blindern, N-0317 Oslo, Norway Received 11 June 2003; received in revised form 4 March 2004; accepted 15 March 2004 Abstract Limited research has investigated how physician–patient interaction changes over time. We have therefore examined physician–patient communication during the two initial, as well as the seventh (on average) patient visit to a haematology outpatient clinic. Consultations were audio taped and analyzed using the Roter interaction analysis system (RIAS). Patients completed the Impact of Events Scale (IES) before and a satisfaction questionnaire after each consultation. Consultations were generally physician dominated and task-focused. While the amount of task-focused communication was significantly reduced between the initial and the return visits, the amount of socio-emotional communication remained quite stable. In return visits (but not in the two initial visits), patients with more severe diagnoses were given longer consultations and they provided more task-focused information to a less verbally dominant physician. Patients were more satisfied in the second and return visits (but not in the first), if consultations contained greater levels of socio-emotional communication. © 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Physician–patient interaction; Verbal dominance; Socio-emotional communication; Satisfaction 1. Introduction Clinical experience indicates that the communication between physician and patient changes from initial to es- tablished encounters in specialist care, reflecting changing needs of the patients in progressive consultations. However, research thus far on the physician–patient relationship has largely unexplored how the communication develops from initial to return visits. A better understanding of this process could have impli- cations for medical education and clinical practice, as well as for future research. So far, research in communication be- tween physician and patient has found various associations between specific communication elements and patient out- come measures [1,2]. The associations, however, are com- plex and difficult to synthesize, and predictive values have been difficult to document in randomized, controlled stud- ies [3–6]. One reason for this may be that research on the physician–patient relationship has been too general in ap- proach. Previous studies may not have sufficiently consid- ered the different communicative needs in patients, which, for example, depend upon whether the consultation is an ini- * Corresponding author. Tel.: +47-22-85-10-19; fax: +47-22-85-13-00. E-mail address: p.k.graugaard@basalmed.uio.no (P.K. Graugaard). tial or a return visit, the clinical setting and condition, and patient personality factors. To our knowledge, only two earlier studies have exam- ined how communication between physician and patient de- velops from initial to later encounters in specialist care for adults. Van Dulmen et al. [7] examined the first three con- sultations between one physician and 18 patients, who were referred because of poorly controlled non-insulin dependent diabetes mellitus. They found that the initial consultations were longer (28 min) than the second (11 min) and third (9 min) consultations. Concerning the relative distribution of socio-emotional and task-focused communication, changes across consultations were small for the physician, whereas patients increased the level of socio-emotional conversation in the later consultations at the expense of task-focused com- munication. Satisfaction scores did not differ between time points. Ford et al. [8] examined the structure and content of the bad news cancer consultations (two linked consulta- tions of newly referred patients; 73 patients saw the same physician for both consultations). The duration of the first consultation was 30 min, compared with 14 min for the sec- ond consultation. The first and second consultations were similar regarding the predominance of biomedical exchange. The ratio of total physician versus patient utterances was 1.49 during consultation one, which decreased to 1.37 dur- ing consultation two. 0738-3991/$ – see front matter © 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2004.03.014