Physician Practice Styles and Patient Outcomes: Differences Between Family Practice and General Internal Medicine.
Bertakis, Klea D. MD, MPH *; Callahan, Edward J. PhD *; Helms, L. Jay PhD +; Azari, Rahman PhD ++; Robbins, John A. MD, MHS [S]; Miller, Jill BS
36(6):879-891, June 1998.
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.
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