Levels of physician involvement with psychosocial concerns of individual patients: A developmental model

Background: Physician involvement in patients' psychosocial concerns is seen as desirable by practicing physicians and family medicine educators. Although the effectiveness of several approaches to psychosocial problems has been demonstrated, the skills required of the physician vary widely. We present a five-level developmental model of physician skills in addressing the psychosocial concerns of individual patients. Methods: To validate the model, 171 outpatient office visits in a residency program were videotaped and rated according to the levels. The inter-rater agreement was 88%. Results: Interviews with lower levels of psychosocial involvement occurred much more frequently than interviews rated at higher levels (48%, 34%, 16%, 2%, 0%, respectively). Involvement at each higher level added approximately two minutes to the length of the visit. The development of higher levels of physician involvement between the first and third year of residency training was not found in this sample. Conclusions: These results support the validity of the five-level sequence regarding the depth of physician involvement. Because the hierarchy can be used to reliably assess the degree of physician involvement with the psychosocial concerns of individual patients, the model offers potential applications for resident education and further research on the physician-patient relationship.