Physician Practice Styles and Patient Outcomes: Differences between Family Practice and General Internal Medicine

• Published in: Medical care 1998-06, Vol.36 (6), p.879-891
• Main Authors: Bertakis, Klea D., Callahan, Edward J., Helms, L. Jay, Azari, Rahman, Robbins, John A., Miller, Jill
• Format: Article
• Language: English
• Subjects: Adult; Aged; California; Counseling; Family physicians; Family practice; Family Practice - standards; Female; Health care outcome assessment; Health outcomes; Health Services Research; Health Status; Hospitals, University; Humans; Internal medicine; Internal Medicine - standards; Male; Medical practice; Middle Aged; Outpatient Clinics, Hospital - standards; Patient Participation; Patient Satisfaction; Physician-Patient Relations; Physicians; Practice Patterns, Physicians' - standards; Prospective Studies; Questionnaires; Surveys and Questionnaires; Treatment Outcome
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/00005650-199806000-00011

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.