Table 1 Descriptive information on observations and examples of instrumental and socioemotional communication

Urban (Mary)

19 patient visits observed

● Patient asks about test results

● Greet each other by their first name

270 minutes of observation

Average of 11 minutes per visit

● Patient asks for refills

● Patient asks about physician’s daughter and what grade she’s in now

(range 5 to 20 minutes)

● Patient asks when test results will be back

● Patient teases physician about being tanned from recent vacation

● Physician asks about symptoms

● Physician asks about how patient’s sibling is coping

● Physician explains tests being scheduled for patient

● Patient and physician talk about people they both know who are retiring

● Physician explains prescriptions and side effects

● Physician teases patient about smoking

● Physician reviews test results

Urban (John)

18 patient visits observed

● Patient describes symptom

● Greet each other by first name

220 minutes of observations

Average of 11 minutes per visit

● Patient asks about health coverage of tests, medications

● Patient jokes that he is there because his wife told him to come in

(range 4 to 19 minutes)

● Patient asks for refills

● Physician teases patient about being an “empty nester”

● Patient asks about their self diagnosis (e.g., thyroid problem, appendix, cancer)

● Physician asks about patients’ parent’s recent surgery, about son in overseas, say “hi” to dad

● Physician explains medications and side effects

● Physician ask how patient’s recent trip was traveling with babies

● Physician asks patient if s/he has any questions about treatment or prescriptions

● Physician explains tests being scheduled for patient

● Physician reviews test results

Rural (Alan)

23 patient visits observed

● Patient describes symptoms and health concerns

● Greet each other by first name

275 minutes of observations

Average of 12 minutes per visit

● Patient asks about health coverage of treatment

● They joke about aging, failing knees, bunnies do well eating salads, giving up coffee, golf not being exercise

(range 3 to 19 minutes)

● Patient asks about prescriptions and side effects

● Talk about summer vacations, exercise routine, daughter getting married, grandson in hockey tournament, restoring cars, hockey game last night, family conflicts and estrangements

● Physician reviews test results

● Physician teases patient about drinking too much at local weekend party

● Physician explains tests being scheduled for patient

● Doctor refers to some patients as “My Dear”

● Physician explains health concerns

● Physician asks patient how he’s doing and pats patient’s knee

● Physician asks about symptoms

● Physician talks to teens about sex, tattoos, drinking and drugs

Rural (Colleen)

13 patient visits observed

● Patient asks about tests and referrals

● Greet each other by first name

297 minutes of observations

Average of 13 minutes per visit

● Patient describes tests and referrals

● They joke about patient falling off examining table and a good looking doctor to come help her up, about weight loss, quitting smoking,

(range 4 to 30 minutes)

● Physician asks about symptoms

● Talk about deer eating flowers, each others’ daughters, retirement celebration for a physician in the clinic, parent who is recently widowed, vacation, sister’s health, new haircut

● Physician explains test results

● Physician explains procedures

● Physician explains health concerns