Levels of physician involvement with patients and their families: A model for teaching and research

M. K. Marvel, R. Schilling, W. J. Doherty, M. A. Baird

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Background. We present an educational model that describes physician skills for addressing psychosocial concerns of patients, ranging from basic medical questions to in-depth psychotherapy. This model improves upon previously published models by integrating into one hierarchy levels of physician involvement with individual patients and levels of involvement with families. Methods: Ten faculty family physicians were videotaped during 200 office visits. Interviews were categorized according to the model, with a 79% interrater agreement. Results. Most visits involved the lower three levels of physician involvement (41%, level 1; 35.8%, level 2; and 23%, level 3). Discussion of family context occurred in a majority (58.5%) of visits, primarily when another family member was in the room and during preventive care visits. Higher levels were associated with longer visits-about 3 minutes more for each additional level. Conclusions. This investigation suggests that the levels of physician involvement model can be reliably measured. This model may be a useful tool for education and research, particularly the study of physician interview skills appropriate to family medicine.

Original languageEnglish (US)
Pages (from-to)535-544
Number of pages10
JournalJournal of Family Practice
Issue number6
StatePublished - 1994


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