Michael Barton Laws, Ph.D., M.A.
Asst Professor of Health Services Policy & Practice (Rsch)
Public Health-Health Services Policy & Practice
Work: +1 401-863-6977
I am a medical sociologist with a particular interest in people's experience of health and illness and of medical services; and provider-patient relationships and communication. I use both quantitative and qualitative methods. A great challenge in the study of interpersonal communication is bridging the gap between the highly reductionist quantitative methods that have so far been used; and the rich description of qualitative methods. Our current work is focused on that problem.
BiographyDr. Laws has studied the patient experience of illness and health care for 15 years. He has been particularly influenced by his studies under the late Irving Kenneth Zola, a pioneer in the sociology of chronic illness and disability. As evaluator of numerous federally funded behavioral health services for people with HIV, he developed a commitment to clinical research based in the patient's perspective. He has focused particularly on physician-patient communication, including the construction and measurement of patient agency in medical encounters. He developed the Generalized Medical Interaction Analysis System, which has been the basis of several published studies. The long-term goal of his research is to support the continuing transformation of medicine and health care more broadly into an institution built around patients' needs physical, psychological, and social; which meets those needs effectively; and in which patients have ultimate agency and authority.
Research DescriptionI am currently engaged in four main programs of research.
The Generalized Medical Interaction Analysis System is a method for coding and analyzing provider-patient communication. It is based on Speech Act Theory, an influential tradition in socio-linguistics based on work by John Searle and J.L. Austin. Speech acts are essentially the social acts embodied in utterances, such as questioning (in fact there are many different kinds of questions), instructing, representing reality, promising, and many others. We decompose transcripts of clinical encounters into individual speech acts, label the type of speech act, and separately label the subject matter ("topic") of the utterance. Topic codes were based on concepts used in previous work by others, but are much more detailed. Topic codes may be expanded in any particular area of interest depending on the focus of the study.
We have also developed software, called Interview Analyzer, to facilitate coding. IA can also be used to implement any system for coding transcripts of interpersonal communication.
The GMIAS has generated many kinds of insights into the performance of the patient and physician roles, interaction processes, and the allocation of time in medical visits. We have published studies on communication about antiretroviral adherence and about sexual risk behavior; and the relationship of visit length with indicators of patient-centered communication throughout the visit.
With my colleague Mary Catherine Beach at Johns Hopkins University, I am co-investigator for Improving ARV Adherence Through Enhancement of HIV Providers' Counseling Skills, (Grant #1R34MH089279-01A1). Our colleague Gary Rose from the Massachusetts Institute of Professional Psychology is training HIV care providers -- both physicians and nurse-practitioners -- in Motivational Interviewing skills, and we are evaluating the results of the intervention. We believe we can demonstrate that this is a promising and cost-effective way to improve people's adherence to medications and other disease management and self-care behaviors, while enhancing the provider-patient relationship and providers' job experience.
As of this writing, I am hopeful I will soon receive funding for Explanatory models and decision heuristics in HIV care. People's perception and understanding of their health condition generally differs from that of their physicians. This is in part a matter of perspective. It is said that physicians' explanatory models are biological, abstract, and reductionist; while patients models are bio-psycho-social, specific, and holistic. This is really a fancy way of saying that people live with their bodies and minds, and their state of health is inseparable from the rest of their life world. Physician models are called diseases, patient models are called illnesses.
But they also differ in concrete ways. Few people have a deep understanding of biological science, so they attach whatever pieces of information they come across, whether from their doctors or other sources, to the available frameworks. For example, many people with HIV think of drug resistance as a change in their bodies, in contrast to the physician's explanation that it is a change in the virus resulting from Darwinian evolution. This can motivate behavior which is contrary to what the physician recommends, in this particular case occasionally suspending medication taking, rather than strict adherence.
We will first develop a taxonomy of people's explanatory models and how they interact with their decision heuristics about medication taking and other self-care practices, using semi-structured interview. We will then develop a structured assessment based on this information, to quickly identify issues about which patients could benefit from education, or a conversation with their provider.
We hope to extend this kind of work to other conditions, such as pediatric hematopoetic stem cell transplant.
Finally, with funding through a supplement to an R01 award to my colleague (and Department Chair) Ira B. Wilson (Grant #3R01MH083595-03S1), we are developing a method called the Comprehensive Assessment of Clinical Encounters System. As useful as the GMIAS has been, a major limitation of it and all similar systems is that it merely allows us to count events. It does not capture the dimension of time, the dynamic process of interaction. Efforts to use information about the sequence of events in interpersonal interaction have largely foundered on mathematical intractability.
We are trying to solve this problem by imposing a layer of higher order structure on the speech act information: the specific problems or issues which arise in the visit, the various processes through which they are addressed, and the nature of the resolutions (if any) of the issues. Within this structure, we believe the sequence information will be much more analytically tractable and interpretable.
AffiliationsAmerican Academy on Communication in Health Care
R01 MH 083595-01A1 (Wilson PI) 7/1/08-6/30/11
Analyzing Patient-Provider Communication to Understand Disparities in HIV Care.
This project will use a new method to analyze audiotapes of routine office visits to understand how patient-provider dialogue differs by race and ethnicity.
5R01 ES 015462-02 (Brugge PI) 6/13/08-3/31/13
Community Assessment of Freeway Pollution and Health
To study the relationship between air pollutants emitted from motor vehicles on major highways and chronic health effects in individuals living in nearby communities.
5P30 AI 042853-12 (Carpenter PI) 7/1/09-6/30/11
CFAR Development Award Sub-Project ID: 9010
Physician and Patient Perspectives on Motivational Interviewing to Support ART Adherence
(Subcontract from Brown University)
Role: PI for Developmental Award
R34 PAR-06-248 (Laws) 08/13/10 04/30/12 4.8 calendar months
Improving ARV Adherence through Enhancement of HIV Providers' Counseling Skills
(Subcontract from Johns Hopkins University)
Role: PI of Subcontract
2K24 MH-092242-06 (Wilson) 07/01/10 - 06/30/15 0.36 calendar months
Improving the Diagnosis and Treatment of Medication Adherence Problems in HIV
To improve adherence to prescribed medication regimens and thereby long-term health outcomes of persons with chronic conditions.
VA, RRP 10-195 (Bokhour, PI) 01/01/11 12/31/11 1.20 calendar months
ENRM VA Hospital 16,605
Evaluating implementation of an HIV adherence informatics intervention.
R01 AG 0022521 (Wilson PI) 7/1/04-6/30/09
Explaining Disparities in the Care of Older Patients
To identify how the communication process mediates the relationship among patient factors, physician factors, and diagnosis and treatment of theses two common clinically significant conditions.
DHHS/CDC/NCHSTP U65/CCU123858 07/01/2004-01/19/09
Evaluation of HIV counseling, testing and referral program
Role: Project Evaluator
DHHS/HRSA 2 H1 2HA 23060 09/30/2001-01/19/09
Evaluation of HIV clinical case management program
Role: Project Evaluator
DHHS/SAMHSA/CSAT 1 H79 TI018952 09/30/2007-01/19/09
Evaluation of outpatient substance abuse treatment program
Role: Project Evaluator
DHHS/SAMHSA/CMHS 1 H79 TI017778 09/30/2007-01/19/09
Evaluation of adolescent and family outpatient substance abuse treatment program
Role: Project Evaluator
DHHS/SAMHSA/CSAT 1 U79 SM058196 09/30/2007-01/19/09
Evaluation of outpatient child traumatic stress treatment program
Role: Project Evaluator
DHHS/HRSA 5/H4AHA 00050 6099979/MAI3 07/01/2008-01/19/09
Evaluation of HIV clinical case management program
Role: Project Evaluator
- 20. Flickinger TE, Rose G, Wilson IB, Wolfe H, Saha S, Korthuis PT, Massa M, Berry S, Laws MB, Sharp V, Moore RD, Beach MC. Motivational interviewing by HIV care providers is associated with patient intentions to reduce unsafe sexual behavior. Patient Education and Counseling. (In press). (IN PRESS)
- 22. Mayfield E, Laws MB, Wilson IB, Rosé, CP. Automating Annotation of Information-Giving for Analysis of Clinical Conversation. Journal of the American Medical Informatics Association. 2013; [Epub ahead of print] PMID: 24029598 (2013)
- 21. Flickinger TE, Berry S, Korthuis PT, Saha A, Laws MB, Sharp V, Moore RD, Beach MC. Counseling to reduce high-risk sexual behavior in HIV care: a multi-cetner, direct observation study. AIDS Patient Care and STDs. 2013;27(7):415-24. PMID:23802144 (2013)
- 18. Fuller CH, Patton AP, Lane K, Laws MB, Marden A, Carrasco E, Spengler J, Mwamburi M, Zamore W, Durant JL, Brugge D. A Community Participatory Study of Cardiovascular Health and Exposure to Near-highway Air Pollution: Study Design and Methods. Reviews on Environmental Health. 2013;28(1):21-35.PMID: 23612527 (2013)
- 17. Laws MB, Bezreh T, Taubin T, Lee Y, Beach MC, Wilson I. Problems and Processes in Medical Encounters: The CASES method of dialogue analysis. Patient Education and Counseling. 2013;91(2):192-9.PMID: 23391684 (2013)
- 15. Laws MB, Beach MC, Lee Y, Rogers WH, Saha S, Korthuis PT, Sharp V, Wilson IB. Provider-patient Adherence Dialogue in HIV Care: Results of a Multisite Study. Aids and Behavior. 2013: 17:1;148-159. PMID: 22290609 (2013)
- 19. Galárraga O, Genberg BL, Martin RA, Laws MB, Wilson IB. Conditional economic incentives to improve HIV treatment adherence: literature review and theoretical considerations. Aids and Behavior. 2013;17:2283-2292. (2013)
- 23. Wallace B, Laws MB, Small K; Wilson IB, Trikalinos, T. Automatically Annotating Topics in Transcripts of Patient-Provider Interactions via Machine Learning. Medical Decision Making. 2013; [Epub ahead of print] PMID: 24285151 (2013)
- 3. Laws, MB Substance Abuse. Encyclopedia of Immigrant Health. Sage. 2012. (2012)
- 2. Laws, MB Health policy. Encyclopedia of Immigrant Health. Sage. 2012. (2012)
- 1. Laws, MB Physician-Patient Communication. Encyclopedia of Immigrant Health. Sage. 2012. (2012)
- 16. Laws MB, Rose GS, Bezreh T, Beach MC, Taubin T, Kogelman L, Gethers M, Wilson IB. Treatment acceptance and adherence in HIV disease: patient identity and the perceived impact of physician-patient communication. Patient Prefer Adherence. 2012;6:893-903. PMID: 23271898 (2012)
- 14. Bezreh T, Laws MB, Taubin T, Rifkin DE, Wilson IB. Challenges to physician-patient communication about medication use: a window into the skeptical patient's world. Patient Preference and Adherence. 2012:6 11-18. PMID: 2272065 (2012)
- 13. Laws MB, Epstein L, Lee Y, Rogers W, Beach MC, Wilson IB. The Association of Visit Length and Measures of Patient-Centered Communication in HIV Care: A Mixed Methods Study. Patient Educ Couns. 2011: 85:e183-e188. PMID: 21592716 (2011)
- 12. Laws, MB, Bradshaw YS, Safren SA, Beach MC, Lee Y, Rogers W., Wilson IB. Discussion of Sexual Risk Behavior in HIV Care is Infrequent and Appears Ineffectual: A Mixed Methods Study. AIDS and Behavior 2011: 14(4): 812-822. PMID: 20981480 (2011)
- 11. Rifkin DE, Laws MB, Rao M, Balakrishnan VS, Sarnak MH, Wilson IB. Medication Adherence Behavior and Priorities Among Older Adults with Chronic Kidney Disease: A Semistructured Interview Study. American Journal of Kidney Diseases. 2010 Sep;56(3):439-46. PMID: 20674113 (2010)
- 10. Wilson IB, Laws MB, Safren SA, et al. Provider focused intervention increases HIV antiretroviral adherence related dialogue, but does not improve antiretroviral therapy adherence in persons with HIV. J Acquir Immune Defic Syndr. 2010 Mar 1;53(3):338-47. PMID: 20048680 (2010)
- 9. White K, Laws MB. Role Exchange in Medical Interpretation. Journal of Immigrant and Minority Health 11(6): 482-493, 2009. PMID: 18975091 (2009)
- 4. Laws, MB, O'Connor J. Review of State Policy to Address Health Disparities in New England. New England Coalition for Health Equity, 2008. (2008)
- 5. Laws, MB Proceedings of Everybody Counts: State Policy to Address Health Disparities. New England Coalition for Health Equity, 2005 (2005)
- 7. Dryden EM, Barrett A, Bhandary K, Laws MB. Report of Disproportionate Minority Contact: Phase II, Assessment. For the State of New Hampshire. Latin American Health Institute, 2004. (2004)
- 7. Laws MB, Heckscher R, Mayo SJ, Wilson IB. A new method for evaluating the quality of medical interpretation. Medical Care, 42(1):71-80, 2004. PMID: 14713741 (2004)
- 6. Flores G, Laws MB, Mayo SJ, Zuckerman B, Abreu M, Medina L, Hardt EJ. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics,111(1):6-14, 2003. PMID: 12509547 (2003)
- 5. Laws MB, Carballeira NP. Use of non-allopathic healing methods by Latina women at mid-life. Am Journ Pub Health [Research Letter], 93(4): 524, 2003. PMID: 12660185 (2003)
- 4. Laws MB, Krech L, Whitman J, Bowser DM. Tobacco availability and point of sale marketing in demographically diverse districts of Massachusetts. Tobacco Control, 11:ii71-ii73, 2002. PMID: 12034986 (2002)
- 3. Laws MB, Heckscher R. Racial and ethnic identification practices in public health data systems in New England. Public Health Reports, 117(1):50-61, 2002. PMID: 12297682 (2002)
- 8. Laws, MB, Sastre F. Report of Disproportionate Minority Confinement: Phase I, Identification. Report to the State of New Hampshire, Dept. of Health and Human Services, 2002. (2002)
- 2. Race and Ethnicity in Biomedical and Health Services Research [letter] Archives of Pediatric and Adolescent Medicine 2001. 155:972-973 (2001)
- 1. Is "globalization" in health care simply a euphemism for Americanization? Journal of Health Services Research and Policy 2001. 6;3:190 (2001)
- 10. Laws MB, Krech L. The Latino Tobacco Control Study. Report to the Massachusetts Department of Public Health Tobacco Control Program. 2000. (2000)
- 9. Laws MB, Cabiya MA, Carballeira NP, Miranda F, Zanini L, Aguilú-Semidey E. Luchando por Nuestro Futuro: The Boston Latino Health Assessment. Report to the Boston Public Health Commission. 2000. (2000)
- 12. Laws MB, Armas C, Whitman J. Latino identifiers in public health data systems in New England. Report for the New England Coalition for Health Equity. 1999. (1999)
- 11. Laws MB, Armas C, Carballeira NP. Project Data Link: racial and ethnic identification in public health data systems. Report to the Massachusetts Department of Public Health, Office of Minority Health. 1999. (1999)
- 14. Laws, M.B.Health Vs. Medicine: The Real Struggle for Health Care Reform. Z Magazine, July/August 1998:77-89 (1998)
- 1. Laws MB, Mayo SJ. The Latina Breast Cancer Control Study. Journal of Community Health, 23;4:251-267, 1998. PMID: 9693984 (1998)
- 3. The special challenges of medicine in a diverse society. The Boston Globe, April 6, 1998, p. A-16 (1998)
- 13. Laws MB, Goldman L. The Boston AIDS Housing Needs Assessment. Report to the City of Boston, Mayor's AIDS Task Force. 1997. (1997)
- 4. The Real Struggle for Health Care Reform. Peacework. April 1996 (1996)
- 15. Laws, MB. The Immigration Wars: The Meaning of American Nationhood in a Shrinking Planet. Z Magazine. 9:2;31-39. November 1996. (1996)
- 6. Laws, MB The Changing Racial and Ethnic Composition of the New England States 1990 2000. New England Coalition for Health Equity, 2004. (1990)
- 17. Laws, MB. This Mighty Dream: Social Protest in North America. Serial publication in USA, spring-summer 1982 (1982)
- 16. Laws, MB. La Raza Unida de Cristal. Southern Exposure. 10:2, 1982 (1982)
- 8. Brugge D, Edgar T, George K, Heung J, Laws MB. Beyond literacy and numeracy in patient-provider communication: Focus groups suggest roles for empowerment, provider attitude, and language. BMC Public Health, 9:354-365, 2009. PMID: 19772555 (1977)
- 2. Laws MB, Wilson I, Bowser DM, Kerr S. Taking anti-retroviral medications for HIV infection: learning from patients' stories. Journal of Gen Internal Medicine, 15;12:848-858, 2000. PMID: 11119181 (1918)
- Other papers presenting primary data or analysis ()
- Refereed papers ()
- Editorials ()