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Sept. 2, 2003 -- No.434

Adopting some osteopathic traits might help M.D.s boost their patient communication skills

By DAVID WILLIAMSON
UNC News Services

CHAPEL HILL -- Doctors of osteopathy appear to have a different -- in some ways more helpful -- communication style from medical doctors in discussing health issues with patients, a new University of North Carolina at Chapel Hill study suggests.

As a result, medical doctors, also known as allopaths, might learn something from their osteopathic colleagues that could improve patient satisfaction and outcomes, researchers say.

Further research is needed with both kinds of doctors to confirm the findings, investigators say, and to determine if the higher scores osteopaths received in a special evaluation correlate with better patient health and greater satisfaction.

A report on the study appeared last month in the Journal of the Osteopathic Association. The work involved audiotaping and analyzing how allopaths and osteopaths interacted with patients during office visits for physicals, headaches, low back pain and high blood pressure.

Authors are Drs. Timothy S. Carey, an allopath who is professor of medicine at the UNC School of Medicine and director of the Cecil G. Sheps Center for Health Services Research; Thomas Motyka, an osteopathic physician in Chapel Hill; Joanne M. Garrett, research associate professor of medicine at UNC; and Robert B. Keller, an orthopedic surgeon in Maine.

"In this study, osteopathic physicians were easily distinguishable from allopathic physicians by their verbal interactions with patients," Carey said. "Osteopathic physicians, for example, were more likely to use patients’ first names, explain the cause of medical conditions and discuss social, family and emotional impacts of illnesses."

The study, which analyzed 54 patient visits in detail, showed that 79 percent of osteopaths but only 47 percent of allopaths talked about preventive measures with patients. Percentages of the two forms of physician suggesting what patients could do for themselves were 69 percent and 32 percent, respectively. Thirty-eight percent of osteopaths asked, "Do you have any questions?" as opposed to 14 percent of allopaths.

On the other hand, medical doctors were twice as likely to discuss the scientific basis of treatment -- 18 percent vs. 9 percent, he said.

Carey got the idea for the study from a breakfast meeting several years ago with osteopathic physicians at a professional conference.

"They told me that their practice of medicine was distinctly different from that of MDs," he said. "I was frankly skeptical. What they described as distinctly ‘osteopathic’ seemed to me like characteristics that many primary care physicians -- allopathic or osteopathic -- would aspire to."

Since academic principles of osteopathic practice are somewhat formalized and specific to osteopaths, Carey and colleagues translated the principles taught in schools of osteopathy into activities they could measure during an average physician visit.

"We accomplished this with focus groups," the UNC physician said. "Then we audiotaped visits with physicians in Maine and coded the visits using a scale we developed previously. I was a bit surprised by the results. I can't say that the osteopathic doctors are necessarily better than the M.D.s, although characteristics such as discussing patients’ emotional state and preventive interventions are good practice by any physician."

Carey has no interest in getting bogged down in discussions of which form of physician is better, he said.

"My view is that the professions can learn from each other so we can all deliver better health care to our patients."

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Note: Carey can be reached at (919) 966-7100 or Carey@med.unc.edu.
Contact: David Williamson, (919) 962-8596