Consultation time and communication patterns in outpatient care: an observational study in South Korea

Patient-centered care (PCC) has become a global standard for improving communication and health outcomes. However, in time-pressured clinical settings, especially in high-volume outpatient systems such as South Korea’s, the implementation of PCC remains challenging. While consultation time is often cited as a key barrier, few studies have examined how actual communication patterns relate to consultation duration using observational methods. We analyzed 510 audio-recorded outpatient consultations from a secondary-level public hospital in Seoul, South Korea, collected between 2016 and 2018. Communication was manually coded using the Roter Interaction Analysis System (RIAS), a validated method for categorizing each utterance - defined as a single, complete thought or clause - into instrumental (task-oriented) or affective (socio-emotional) domains. Cluster analysis was then used to identify consultation-level communication patterns based on the distribution of RIAS codes. Multinomial logistic regression was conducted to examine associations between communication patterns and consultation time, visit type, physician experience, and other contextual factors. Three distinct communication patterns were identified: biomedical (physician-led and task-oriented), biopsychosocial (a balanced mix of instrumental and affective communication), and consumerist (patient-driven, information-seeking with limited emotional exchange). The biopsychosocial pattern was the most common and occurred in the shortest consultations (mean = 4.07 min). The biomedical pattern occurred in the longest consultations (mean = 6.78 min) and was characterized by a predominance of physician talk, frequent biomedical questions and directives, and a higher rate of interruptions initiated by the physician. The consumerist pattern appeared more frequently among physicians with longer clinical careers. Multinomial logistic regression showed that follow-up visits (OR = 0.49, 95% CI: 0.24 to 0.56) and shorter consultation time (OR = 0.89, 95% CI: 0.80 to 0.95) were associated with the biopsychosocial pattern. Physicians with longer medical careers were more likely to exhibit the consumerist pattern (OR = 1.08, 95% CI: 1.01 to 1.18). Communication patterns are not solely determined by consultation length. Patient-centered interactions can take place within brief consultations, highlighting the need to tailor communication training and care delivery strategies to realistic time constraints in high-volume clinical settings.