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Dictation in the presence of the patient.

We investigated the impact on patients' satisfaction and understanding of their condition and treatment recommendations when the care provider dictated the medical record in their presence. Providers' satisfaction and perceptions were also ascertained. Sixty patients were randomly placed into a treatment group where the provider dictated the medical record in their presence, and 60 patients were placed in a standard visit control group. Volunteer providers included residents, a faculty physician, and a physician assistant. A survey instrument completed with an interviewer measured patients' satisfaction with the provider, their care, the dictation technique, and their understanding of their diagnosis and treatment recommendations. The provider completed a similar questionnaire. Patients in both the dictation and control group were equally satisfied with their care, felt they understood what the provider told them about their medical conditions, and felt they understood their provider's recommendations. Within the dictation group, 44 (73%) liked the process, 24 (40%) believed they were helped to understand their condition, 22 (37%) believed they were helped in understanding recommendations, and 23 (38%) reported improved satisfaction with a visit that included dictation in their presence. In the dictation group, men felt more positive than women about dictation in their presence, including increased understanding of their condition and satisfaction with the visit. Patients aged 56 years and older were also more positive about dictation in their presence, including improvement in their understanding of the provider's recommendations. Providers were equally satisfied with encounters using either method.