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We examined whether four patient characteristics (age, ethnicity, sex and appearance) influenced five physician behaviors with the patient (interviewing, nonverbal attention, courtesy, information giving and empathy). Ten physician-patient interactions were observed through a one-way mirror for each of 15 physicians. Physicians were rated higher on information giving (p = 0.002) and empathic skills (p = 0.02) when they were with female patients; on interviewing (p = 0.02) and empathy (p = 0.0007) with Anglo-American compared with Spanish-American patients; on interviewing (p = 0.01), nonverbal attention (p = 0.001) and courtesy (p = 0.02) when with the best groomed patients; and on courtesy (p = 0.03) with elderly patients. In addition, there were fewer physician-initiated interruptions with female patients (p = 0.03) and with well-groomed patients (p = 0.02). Each of the four patient characteristics studied acted independently in influencing physician behavior. The recognition that patient characteristics influence physician behavior should stimulate physicians to examine their reactions in order to insure that all types of patients receive thorough, courteous and empathic care.

An investigation into social relationships and their connection to health was integrated into a 5-year prospective study of nutrition and immunobiology in 300 healthy elderly persons. The data were collected from a subsample of 40 individuals by interview, using the Interview Schedule for Social Interaction (ISSI), the Rotter I-E Locus of Control Scale, and the Multidimensional Health Locus of Control Scale (MHLC). This group did not differ from the general population in terms of their social relationships. The mean locus of control expectancy score was 6.5 +/- 3.3, indicating an internal group. There was a statistically significant relationship between internality and availability of social integration, but no differences based upon sex or age for the ISSI or Rotter's I-E Locus of Control Scale.

The behavior of 15 internal medicine residents, each with 10 patients, was observed through a one-way mirror. Ratings by the patients of satisfaction with their physicians were also obtained. Patient satisfaction correlated strongly with ratings for physician courtesy and information-giving, Nonverbal behaviors such as eye contact, bodily positioning, and physical contact did not correlate with patient satisfaction. The correlations between physician behavior and patient satisfaction did not hold for the four women physicians studied.The behavior of 15 internal medicine residents at the University of New Mexico Hospital, each with 10 patients, was observed through a 1-way mirror and the 150 patients rated their satisfaction with their physician. The mean ratings of patient satisfaction were between 6 and 7 on a 7-point scale. Satisfaction ratings did not vary significantly between male or female patients or between Hispanics and Anglos, although patients under 40 years of age tended to provide lower ratings than those over this age. Patient satisfaction correlated highly with physician courtesy (formal greeting and formal closure of the interview) and with information giving. Listening behavior also correlated with patient satisfaction. Physician empathy correlated only weakly with patient satisfaction, while physical attention (eye contact and body positioning) did not correlate at all with this factor. Additional factors that were not significant determinants of patient satisfaction in this study included the physical appearance of the physician, the total time of physician-patient interaction, and the amount of physical contact between patient and physician. There were no significant differences between male and female physicians in the mean ratings of caring behaviors or satisfaction. The satisfaction scores of male patients with female physicians were the same as patients of either sex with male physicians; however, female patients expressed greater satisfaction with their female physicians than did male patients with female physicians or female patients with male physicians. This study confirms the findings of earlier investigators that patient satisfaction is beneficially influenced by friendliness and information provision on the part of the physician.

Dietary and supplemental intakes were assessed from 3-day food records collected from 270 free-living, middle income and healthy men and women over 60 yr of age residing in the Albuquerque, NM vicinity. The 1980 Recommended Dietary Allowances (RDA) were used to assess adequacy of intake. Energy intake, as percentage of the RDA, was 90 +/- 23 (mean +/- SD) for men (n = 125) and 87 +/- 22 for women (n = 145). Mean daily protein intake was 83 g for men and 67 g for women and only 11% of men and 14% of women failed to receive at least 100% of the RDA for protein. Frequency and amount of vitamin and mineral supplementation was substantial. Approximately 60% of both men and women ingested one or more supplements; vitamins C and E were the most popular. In general, dietary intakes in this population appear to be adequate with the possible exception of vitamin D and calcium intakes in women.

This study was designed to obtain information on normal dietary intake and serum levels of choline in a healthy elderly population and to observe the relationship between blood levels of choline and cognitive function. Two hundred fifty-eight healthy volunteers with a mean age of 72 years were recruited, and blood samples and dietary histories were obtained. All subjects were ambulatory, living at home, free of serious medical illnesses, and taking no prescription medications. Cognitive abilities were assessed by the Halstead Category Test, a nonverbal test measuring abstract thinking, and the Wechsler Memory Scale, using the multiple scoring method, which measures both long- and short-term memory. The mean value for serum choline was 13.16 micron with a standard deviation of 3.31. Serum choline levels were found to increase with age, but no difference was found between serum choline levels for men and women. There was no association between dietary intake and serum choline levels, nor could a relationship be found between serum choline levels and cognitive function.

or nonspecific "digestive problems," may in fact be caused by mild dumping. We believe that transient dumping may occur more frequently than is recognized. By wrapping less fundus around the esophagus and preserving the lesser omentum, inadvertent vagotomy can be avoided with the same good antireflux result and without producing the complication of dumping. Awareness of this possibility in the pediatric patient who has postprandial gastrointestinal symptoms, sweating, and tachycardia associated with glycosuria should arouse suspicion of the syndrome, and may allow for early diagnosis and successful control of this troublesome symptom complex.