"we'll do this together": The role of the first person plural in fostering partnership in patient-physician relationships

Helen Kinsman, Debra Roter, Gail Berkenblit, Somnath (Som) Saha, Philip (Todd) Korthuis, Ira Wilson, Susan Eggly, Andrea Sankar, Victoria Sharp, Jonathon Cohn, Richard D. Moore, Mary Catherine Beach

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Partnership is integral to therapeutic relationships, yet few studies have examined partnership-fostering communication behaviors in the clinic setting. We conducted this study to better understand how statements in which physicians use the first person plural might foster partnership between patient and provider. Methods: We audio-recorded encounters between 45 HIV providers and 418 patients in the Enhancing Communication and HIV Outcomes (ECHO) Study. We used the Roter Interaction Analysis System (RIAS) to code for statements made by the physician that used the first person plural to refer to themselves and their patient. Using multiple logistic regression, we examined the associations between the occurrence of one or more first person plural statements with patient ratings of provider communication. To better understand the meaning of first person plural statements, we conducted a qualitative analysis. Main Results: Providers were mostly white (69%) and Asian (24%); 57% were female. Patients were black (60%), white (25%), and Hispanic (15%); 33% were female. One or more first person plural statements occurred in 92/418 (22%) of encounters. In adjusted analyses, encounters with first person plural statements were associated with younger patient age (OR 0.97, 95% CI 0.94-0.99), higher patient depression scores (highest tertile compared to lowest tertile: OR 1.89, 95% CI 1.01-3.51), the patient not being on anti-retroviral therapy (OR 0.53, 95% CI 0.29-0.93), and older provider age (OR 1.05, 95% CI 1.00-1.09). After adjustment, patients were less likely to highly rate their provider's communication style if first person plural statements were used (AOR 0.57, 95% CI 0.33-0.96). There were 167 first person plural statements made by physicians in the 418 encounters. Qualitative analysis revealed that many first person plural features had at least one negative feature such as being overtly persuasive ("That's going to be our goal"), indirect ("What can we do to improve your diet?"), or ambiguous ("Let's see what we can do"), although there were also positive statements that involved patients in the health-care process, contributed to a mutual understanding, and addressed the patients' goals. Conclusions: Contrary to our hypotheses, use of first person plural was not associated with higher ratings of provider communication, probably because some of these statements were overtly persuasive, indirect, or ambiguous. Physicians should become aware of benefits and pitfalls of using the first person plural with patients. Further research is needed to determine the most effective methods through which providers can build alliances with patients.

Original languageEnglish (US)
Pages (from-to)186-193
Number of pages8
JournalJournal of General Internal Medicine
Volume25
Issue number3
DOIs
StatePublished - Mar 2010

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Physician-Patient Relations
Foster Home Care
Communication
Physicians
HIV
Social Adjustment
Hispanic Americans

Keywords

  • HIV/AIDS
  • Partnership
  • Patient-centered care
  • Patient-provider communication
  • Patient-provider relations

ASJC Scopus subject areas

  • Internal Medicine

Cite this

"we'll do this together" : The role of the first person plural in fostering partnership in patient-physician relationships. / Kinsman, Helen; Roter, Debra; Berkenblit, Gail; Saha, Somnath (Som); Korthuis, Philip (Todd); Wilson, Ira; Eggly, Susan; Sankar, Andrea; Sharp, Victoria; Cohn, Jonathon; Moore, Richard D.; Beach, Mary Catherine.

In: Journal of General Internal Medicine, Vol. 25, No. 3, 03.2010, p. 186-193.

Research output: Contribution to journalArticle

Kinsman, H, Roter, D, Berkenblit, G, Saha, SS, Korthuis, PT, Wilson, I, Eggly, S, Sankar, A, Sharp, V, Cohn, J, Moore, RD & Beach, MC 2010, '"we'll do this together": The role of the first person plural in fostering partnership in patient-physician relationships', Journal of General Internal Medicine, vol. 25, no. 3, pp. 186-193. https://doi.org/10.1007/s11606-009-1178-3
Kinsman, Helen ; Roter, Debra ; Berkenblit, Gail ; Saha, Somnath (Som) ; Korthuis, Philip (Todd) ; Wilson, Ira ; Eggly, Susan ; Sankar, Andrea ; Sharp, Victoria ; Cohn, Jonathon ; Moore, Richard D. ; Beach, Mary Catherine. / "we'll do this together" : The role of the first person plural in fostering partnership in patient-physician relationships. In: Journal of General Internal Medicine. 2010 ; Vol. 25, No. 3. pp. 186-193.
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abstract = "Background: Partnership is integral to therapeutic relationships, yet few studies have examined partnership-fostering communication behaviors in the clinic setting. We conducted this study to better understand how statements in which physicians use the first person plural might foster partnership between patient and provider. Methods: We audio-recorded encounters between 45 HIV providers and 418 patients in the Enhancing Communication and HIV Outcomes (ECHO) Study. We used the Roter Interaction Analysis System (RIAS) to code for statements made by the physician that used the first person plural to refer to themselves and their patient. Using multiple logistic regression, we examined the associations between the occurrence of one or more first person plural statements with patient ratings of provider communication. To better understand the meaning of first person plural statements, we conducted a qualitative analysis. Main Results: Providers were mostly white (69{\%}) and Asian (24{\%}); 57{\%} were female. Patients were black (60{\%}), white (25{\%}), and Hispanic (15{\%}); 33{\%} were female. One or more first person plural statements occurred in 92/418 (22{\%}) of encounters. In adjusted analyses, encounters with first person plural statements were associated with younger patient age (OR 0.97, 95{\%} CI 0.94-0.99), higher patient depression scores (highest tertile compared to lowest tertile: OR 1.89, 95{\%} CI 1.01-3.51), the patient not being on anti-retroviral therapy (OR 0.53, 95{\%} CI 0.29-0.93), and older provider age (OR 1.05, 95{\%} CI 1.00-1.09). After adjustment, patients were less likely to highly rate their provider's communication style if first person plural statements were used (AOR 0.57, 95{\%} CI 0.33-0.96). There were 167 first person plural statements made by physicians in the 418 encounters. Qualitative analysis revealed that many first person plural features had at least one negative feature such as being overtly persuasive ({"}That's going to be our goal{"}), indirect ({"}What can we do to improve your diet?{"}), or ambiguous ({"}Let's see what we can do{"}), although there were also positive statements that involved patients in the health-care process, contributed to a mutual understanding, and addressed the patients' goals. Conclusions: Contrary to our hypotheses, use of first person plural was not associated with higher ratings of provider communication, probably because some of these statements were overtly persuasive, indirect, or ambiguous. Physicians should become aware of benefits and pitfalls of using the first person plural with patients. Further research is needed to determine the most effective methods through which providers can build alliances with patients.",
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