Meaning of illness and health outcomes in type 1 diabetes.

OBJECTIVE: To determine whether a relationship exists between the meaning attributed to type 1 diabetes and mental and physical health outcomes. METHODS: The study sample consisted of 49 adults with type 1 diabetes. Each participant voluntarily agreed to complete the Meaning of Illness Questionnaire (MIQ), the Short Form-36 Health Survey (SF-36), and the Diabetes Health Survey. Multivariant analysis of covariance was used to determine the relationships among the MIQ and SF-36, a history of depression, hemoglobin A1c, and other demographic variables. RESULTS: The meaning attributed to illness predicted health outcomes. Specifically, the impact of illness (MIQ subscale 1; P = 0.030) predicted SF-36 physical functioning, bodily pain, and general mental health; the degree of stress (MIQ subscale 3; P = 0.008) predicted SF-36 general physical health, vitality, and general mental health. Conversely, a history of depression (P = 0.014) and high hemoglobin A1c (P = 0.039) predicted a more negative meaning attributed to illness. CONCLUSION: The meaning attributed to illness varies with physical and mental health. In addition, physical and mental health outcomes and hemoglobin A1c, a measure of mean blood glucose, affect the meaning attributed to diabetes. The findings in this study support a bidirectional relationship between the meaning attributed to illness and health outcomes in patients with type 1 diabetes.

Speaking and interruptions during primary care office visits.

BACKGROUND: Patients and physicians value effective communication and consider it an essential part of the medical encounter. This study examined physician-patient communication patterns, and interruptions in communication, during patient visits with family practice and internal medicine residents. METHODS: Observational data obtained from 60 routine primary care office visits included the time that resident physicians and patients spoke and the number and types of interruptions. A total of 22 family practice and internal medicine residents participated, 9 from family practice and 13 from internal medicine. RESULTS: Patients spoke, uninterrupted, an average of 12 seconds after the resident entered the room. One fourth of the time, residents interrupted patients before they finished speaking. Residents averaged interrupting patients twice during a visit. The time with patients averaged 11 minutes, with the patient speaking for about 4 minutes. Computer use during the office visit accounted for more interruptions than beepers. Verbal interruptions, a knock on the door, beeper interruptions, and computer use all interfered with communication, and increased frequency of interruptions are associated with less favorable patient perceptions of the office visit. Female residents interrupted their patients less often than did male physicians. All residents interrupted female patients more often than male patients. Early and increased interruptions were associated with patients' perception that they should have talked more. Third-year residents interrupted patients less frequently than did first-year residents. CONCLUSIONS: Numerous interruptions occurred during office visits. Gender was associated with the pattern of interruptions. Physicians frequently interrupted patients before the patients were finished speaking. Computer use also interrupted physician-patient communication.