Psychosocial talk in geriatric medical encounters: The impact of physician validation, physician dominance, and the presence of a companion

A growing body of research suggests that the biopsychosocial approach in primary care is the most effective type of care, particularly for elderly patients. The physician-patient relationship has long been studied as an important component of medical care, though research to date is commonly descriptive, atheoretical, and/or methodologically flawed. The current study analyzes videotapes of older adults in medical encounters to understand the relationship between physician behaviors and the discussion of psychosocial topics. The goal of the study is to determine if physician dominance, physician validation and invalidation impact psychosocial talk. The project also describes the often-overlooked presence of a companion in medical encounters. Hypotheses were tested using data from a sub-sample (n = 144) of the ADEPT archived videotapes. One-half of the videotapes included interactions with a patient companion present. The MDIA coding system was used to code the content of interactions, and Validation/Invalidation Coding System as adapted for medical encounters was used to measure validation and invalidation. Mixed model analysis is the most suitable method for fitting multilevel models, and was used to account for patient clustering within physician. Results indicate that more validation is associated with more psychosocial talk and more physician dominance is associated with less psychosocial talk. There was more psychosocial talk observed in dyads than triads, and physicians were more dominating in dyads. The findings are congruent with prior research linking empathy and components of validation with psychosocial talk, however it is the first to present a theoretical model explaining the mechanism driving this relationship. According to self-verification theory, the validating comments function to reduce anxiety and enhance learning, engendering an interaction in which the private nature of psychosocial topics is more readily included. In this study, older patients do not benefit from having a more dominating physician, challenging the assumption that older adults prefer the paternalistic model of medicine. The findings also indicate that medical communication research with older adult patients should account for the presence of companions and support the preservation of private patient-physician communication, at least for part of a medical visit.