The assessment of reactivity in direct observation studies of doctor-patient interactions

A number of recent studies have used the direct observation technique to explore the nature of the medical consultation and its impact on outcomes such as diagnosis, adequacy of care, patient compliance and satisfaction. However, none of these included adequate assessments of the reactive effects of the observation procedure. The present research aimed at extending the current understanding of reactive effects in observation studies of doctor-patient interactions, and was part of a larger study involving the videotaping of over 2000 consultations in the primary care setting. Habituation to the observation procedure was assessed by examining changes over time in the doctor's rates of identifying smoking and psychiatrically disturbed patients. Data from 20 doctors and 619 consultations were assessed for smoking detection and 22 doctors and 564 consultations for psychiatric disturbance. When differences between sessions in case mix and the differential ability of individual doctors to detect were controlled for, there was no evidence of changes in the doctor's behaviour over time. Self-report measures of responses to the observation procedure were collected from 17 primary care physicians and 279 patients. While patients reported no reactive effects, the doctors felt that some aspects of their behaviour had been altered by the study procedures. Results are discussed in terms of strategies for assessing reactivity within observational studies of doctor-patient interactions.