The purpose of physician-patient communication is to create a good physician-patient relationship, promote mutual understanding between physicians and patients, and reduce medical disputes [1, 2]. However, in the emergency department, where speed and efficiency are emphasized, each patient only has an average of 14 s to speak, and only 16% of patients are asked if they have inquiries or understand the information provided by the hospital . This indicates that physician-patient communication is primarily physician-oriented, and few actually attend to the needs of patients. In this regard, important information cannot be conveyed effectively. In addition, there is always a large number of patients in the emergency department, leading to preoccupation and congestion as well as insufficient human resources, which causes medical personnel to have very short and fleeting fractions of time to make judgments [2,3,4]. Insufficient communication can easily lead to a tense relationship between physicians and patients , which is concomitant with negative patient experience, low career satisfaction as a physician, medical negligence, and other problems . Hence, the establishment of effective physician-patient communication is both a pressing need and challenge for emergency departments.
Good physician-patient communication includes instrumental and emotional behavior. The former includes providing information, enquiring medical history, discussing treatment options, explaining an illness, examining the results, etc. [6, 7]. Provision of information is the most common instrumental communication, accounting for 35.3%, followed by medical history inquiry, accounting for 23%, which mostly consists of closed-ended questions . Emotional communication includes self-introduction, calling the patients by their name, giving encouragement and confidence, expressing friendliness, concern, empathy, etc. [6, 9]. Calling the patients by their name is the most common form, accounting for 71.8% . This communication behavior is mainly conveyed through non-verbal expressions such as intonation, eye contact, posture, laughter, facial expression, touch, and distance. Even though oral communication only accounts for 7% [10, 11], it is a key determinant of patient satisfaction. In addition, the use of words is key to effective communication. Good physician-patient communication depends on physicians’ ability to interpret medical language into everyday language, thereby assisting patients to gain a basic understanding of medical language [5, 12]. However, Bourhis et al.  further pointed out that the change of words should also consider the understanding and acceptance of patients to shorten the communication gap between physicians and patients.
The Roter Interaction Analysis System (RIAS) is one of the most common evaluation tools and is widely used to explore outpatient medical services in different departments [14, 15]. MaCarthy et al.  analyzed the content of physician-patient dialogues and found that emergency physicians occupied a significantly higher amount of dialogue compared to patients, among which most of the dialogue covered patient education and consultation (34%), followed by stimulating patients’ positivity, building relationships with patients, and collecting data. In the dialogue, life and medical themes (86%) accounted for a much higher proportion than psychosocial and social themes (14%). The patients’ dialogue focused on providing information (47%) and building relationships (45%), while asking questions was only 5%. The results showed that dialogue content was mainly about conveying useful information to the other party in the emergency department, and the scores of patient-centered items were low. However, Pun et al.  and Levinson et al.  pointed out that physicians only require 30 to 60 s to introduce themselves to patients and ask about the chief complaint, and they should listen attentively, show a respectful and friendly attitude and use a peaceful tone, and ask questions in a timely manner to promote mutual understanding, which can greatly improve the quality of physician-patient communication and interaction. On the other hand, the same effect can be achieved by allowing patients to express their condition fully. Langewitz et al.  pointed out that the average time of patients’ free talk was less than 1 min and 40 s, and 78% of patients finished expressing themselves within two minutes. As long as physicians and patients keep an open attitude and participate in the communication process together, a consensus can be achieved , and medical disputes can be reduced [1, 2]. Therefore, physician-patient communication is worth promoting in medical institutions. However, studies related to physician-patient communication mostly focus on general outpatient clinics and rarely target the emergency department [2, 3, 19, 20]. Therefore, in this study, Roter Interaction Analysis System was used to explore the modes of physician-patient communication in the emergency departments of Taiwanese hospitals, and the results are expected to contribute to effective physician-patient communication in the emergency department.
This study adopted the Roter Interaction Analysis System to explore physician-patient behaviors in the emergency departments of Taiwanese hospitals. The results serve as a basis for devising recommendations for effective emergency physician-patient communication and education. The objectives of the study include:
To explore the communication behaviors of emergency physicians.
To provide references for physician-patient communication and education in the emergency department based on the research results.