Examples of Statements Coded as Cutoff, Preliminary Exploration, Further Exploration, and Validation
| Transcript | Coding of the Statement |
|---|---|
| EVC = exploration and validation of patient concerns; Dr = physician; Pt = patient. | |
| Physician-patient sequences with low EVC score | |
| Back pain | |
| Dr: So, what brings you in today? | |
| Pt: My back has been bothering me. | Patient expresses a concern |
| Dr: What kind of work do you do? | Coded as Cutoff: physician does not respond to the concern and changes the topic |
| Pt: Um, well, I was an administrative assistant as of the beginning of January, but I got laid off, so … | Patient expresses another concern |
| Dr: So, recently laid off. | Coded as Preliminary Exploration: missed an opportunity to validate the patient’s concerns |
| Pt: Yes. | |
| Dr: Okay. Okay. And when was your last physical exam, like pelvic exam, breast exam, all that? | Not coded: physician again redirects the conversation, thus response is not scored as Further Exploration; Cutoff coded only once for each patient concern |
| Mood | |
| Pt: I’ve been feeling tired all the time. | Patient expresses a concern |
| Dr: How’s your sleep? | Not coded yet: no acknowledgment or exploration of patient’s experience of tiredness, but asks about a possible cause of tiredness |
| Pt: I can’t fall asleep. | |
| Dr: Do you cry very much? | Coded as Cutoff: cuts off patient and switches topic to something related in the physician’s mind, but not necessarily to the patient |
| Pt: Once in a while. | |
| Dr: Do you feel hopeless? | Does not explore patient’s concerns and switches topics; Cutoff coded only once for each patient concern |
| Physician-patient sequences with high EVC score | |
| Back pain | |
| Dr: So, what brings you in today? | |
| Pt: My back has been bothering me. | Patient states a concern |
| Dr: How so? | Coded as Preliminary Exploration |
| Pt: When I bend over it hurts, and I’m stiff in the morning. | Describes in more detail |
| Dr: Do you remember when it started? | Coded as Further Exploration of the patient’s concerns |
| Pt: Yes. I was moving boxes in my house. | Gives more information |
| Dr: What did it feel like when it started hurting? | More exploration; Further Exploration coded only once for each patient concern |
| Pt: It didn’t start hurting until the next day. | Gives more information |
| Dr: Back pain is pretty annoying, isn’t it? | Coded as Validation: validates patient’s concerns by speaking to her underlying emotions |
| Pt: It sure is. | |
| Mood | |
| Pt: I got laid off when my company moved. | Patient expresses a concern |
| Dr: Oh, I’m sorry to hear that. | Coded as Validation because of expressed empathy |
| Pt: I could have moved with the company and continued my job, but I didn’t want to move. | Expresses more concern |
| Dr: That must have been a difficult decision for you. | Again, validates the patient’s experience, but Validation coded only once for each patient concern |
| Pt: It was, I sometimes wonder if I made the right choice. | Reveals more information |