The Impact of Patient Participation on Physicians' Information Provision During a Primary Care Medical Interview

This study investigated the impact of patients' participation on physicians' information provision during a primary care medical interview. When communicating with high-participation patients, physicians provided significantly more information overall, more information in response to patients' questions, and volunteered more information than when interacting with low-participation patients. The most significant differences with respect to volunteered information involved communication about treatment and tests or procedures. These results were interpreted to suggest that high-participation patients' communication style promotes better alignment of patients' and physicians' goals and agendas.

Overall, the results suggest that patients' style of participation during a medical interview significantly influenced the extent and type of information physicians provided. Given that patients' biggest complaint about physicians often is a lack of desired information, this study has important implications for physician–patient communication.     

Information Seeking and Satisfaction With Physician–Patient Communication Among Prostate Cancer Survivors

Relatively little is known about prostate cancer patients' information seeking after diagnosis, how they use such information in making a treatment decision, or what role information plays in adjusting to quality-of-life issues posttreatment. This research sought to explore some of these issues by examining prostate cancer patients' information seeking and its relationship to assessments of feeling informed and satisfied with physician–patient communication about prostate cancer. Respondents felt reasonably informed about prostate cancer, although over one third of them reported being less then informed. Similarly, many respondents were generally satisfied with their communication with physicians, but nearly 40% of them reported being less than satisfied. However, there was no relationship between respondents' information seeking about prostate cancer and their assessments of being informed or satisfied with physician–patient communication. These and other results are discussed with respect to future research on prostate cancer patients' information needs and uses of such information.     

Physicians,sick leave certificates,and patients' subsequent employment outcomes

I analyze how general practitioners (GPs) indirectly affect their patients' employment outcomes by deciding the length of sick leaves. I use an instrumental variables framework where spell durations are identified through supply‐side certification measures. I find that a day of sick leave certified only because the worker's GP has a high propensity to certify sick leaves decreases the employment probability persistently by 0.45–0.69 percentage points, but increases the risk of becoming unemployed by 0.28–0.44 percentage points. These effects are mostly driven by workers with low job tenure. Several robustness checks show that endogenous matching between patients and GPs does not impair identification. My results bear important implications for doctors: Whenever medically justifiable, certifying shorter sick leaves to protect the employment status of the patient may be beneficial.     

Patients' desires and satisfaction in general medicine clinics.

Most patients have explicit desires or requests when they visit their physicians. Identification of patients'' requests and needs is the starting point of a patient-centered approach to care. The frequency with which physicians met their patients'' desires for services and that frequency''s association with patient satisfaction were examined for 243 patients with chronic disease in general medicine clinics of a Department of Veterans Affairs hospital. Patients desired a mean of 11.9 services, of which an average of 67 percent were met. However, many patients'' desires for information and most of their desires for help with emotional and family problems were not met. Patients with the most unmet desires for services, especially services related to information, were significantly less satisfied with their physicians than were those with fewer unmet desires. Factor analysis was used to develop a short, 16-item Requests for Services Questionnaire that appeared to cover the range of services that patients with chronic conditions desire. Enhancing physicians'' ability to recognize and respond to patients'' desires for services by using short patient request questionnaires may have the potential to improve patient satisfaction and other health care outcomes.     

Factors Influencing Patient Disclosure to Physicians in Birth Control Clinics: An Application of the Communication Privacy Management Theory

The focus of the current study is whether, and why, female patients limit or alter their personal histories when discussing sensitive subject matter with their physician in birth control clinics. Fifty-six female patients (M?=?21.6 years, SD?=?3.05) completed anonymous questionnaires exploring their comfort with and ability to disclose personal histories in the immediately preceding interview with the physician. The present study used communication privacy management (CPM) as the theoretical lens through which to view the interaction. Approximately one-half of the sample (46%) reported limiting or altering information. Patients with a highly permeable privacy orientation, as evidenced by a history of open communication regarding sexual issues, were those who reported fully disclosing to their physicians. Of the physician characteristics considered to map onto patient privacy rules, the physician's gender, hurriedness, friendliness, use of a first-name introduction, and open-ended questions were significantly related to patients' reported ease in fully disclosing personal information (p < .05). This study presents a novel application of CPM and has implications for training medical students and for parent–child communication regarding sexual issues.     

Physician Communication in the Operating Room

A survey of 104 physicians examined the role of physicians' evaluation of the quality of e-health and beliefs about the influence of patients' use of e-health in how physicians discuss e-health materials with patients. Physicians' lower (poor) evaluation of the quality of e-health content predicted more negative mediation (counter-reinforcement of e-health content). Perceived benefits of patients' e-health use predicted more positive (endorsement of e-health content). Physician's perceived concerns (negative influence) regarding patients' e-health use were not a significant predictor for their mediation styles. Results, challenging the utility of restrictive mediation, suggested reconceptualizing it as redirective mediation in a medical interaction. The study suggested that patient-generated e-health-related inquiries invite physician mediation in medical consultations. Findings and implications are discussed in light of the literature of physician–patient interaction, incorporating the theory of parental mediation of media into a medical context.     

Cost-effectiveness of an activating intervention by social workers for patients with minor mental disorders on sick leave: a randomized controlled trial

BACKGROUND: Sickness absence often occurs in patients with emotional distress or minor mental disorders. In several European countries, these patients are over-represented among those receiving illness benefits, and interventions are needed. The aim of this study was to evaluate the cost-effectiveness of an intervention conducted by social workers, designed to reduce sick leave duration in patients absent from work owing to emotional distress or minor mental disorders. METHODS: In this Randomized Controlled Trial, patients were recruited by GPs. The intervention group (N = 98) received an activating, structured treatment by social workers, the control group (N = 96) received routine GP care. Sick leave duration, clinical symptoms, and medical consumption (consumption of medical staffs' time as well as consumption of drugs) were measured at baseline and 3, 6, and 18 months later. RESULTS: Neither for sick leave duration nor for clinical improvement over time were significant differences found between the groups. Also the associated costs were not significantly lower in the intervention group. CONCLUSIONS: Compared with usual GP care, the activating social work intervention was not superior in reducing sick leave duration, improving clinical symptoms, and decreasing medical consumption. It was also not cost-effective compared with GP routine care in the treatment of minor mental disorders. Therefore, further implementation of the intervention is not justified. Potentially, programmes aimed at reducing sick leave duration in patients with minor mental disorders carried out closer to the workplace (e.g. by occupational physicians) are more successful than programmes in primary care.     

Racial attitudes,physician–patient talk time ratio,and adherence in racially discordant medical interactions

Physician racial bias and patient perceived discrimination have each been found to influence perceptions of and feelings about racially discordant medical interactions. However, to our knowledge, no studies have examined how they may simultaneously influence the dynamics of these interactions. This study examined how (a) non-Black primary care physicians' explicit and implicit racial bias and (b) Black patients' perceived past discrimination affected physician–patient talk time ratio (i.e., the ratio of physician to patient talk time) during medical interactions and the relationship between this ratio and patients' subsequent adherence. We conducted a secondary analysis of self-report and video-recorded data from a prior study of clinical interactions between 112 low-income, Black patients and their 14 non-Black physicians at a primary care clinic in the Midwestern United States between June, 2006 and February, 2008. Overall, physicians talked more than patients; however, both physician bias and patient perceived past discrimination affected physician–patient talk time ratio. Non-Black physicians with higher levels of implicit, but not explicit, racial bias had larger physician–patient talk time ratios than did physicians with lower levels of implicit bias, indicating that physicians with more negative implicit racial attitudes talked more than physicians with less negative racial attitudes. Additionally, Black patients with higher levels of perceived discrimination had smaller physician–patient talk time ratios, indicating that patients with more negative racial attitudes talked more than patients with less negative racial attitudes. Finally, smaller physician–patient talk time ratios were associated with less patient subsequent adherence, indicating that patients who talked more during the racially discordant medical interactions were less likely to adhere subsequently. Theoretical and practical implications of these findings are discussed in the context of factors that affect the dynamics of racially discordant medical interactions.     

Sex and the ‘recently single’: perceptions of sexuality and HIV risk among mature women and primary care physicians

Primary care physicians may mistakenly conclude that sexual issues are unimportant to divorced or widowed mature women, based on age and gender biases. Although research suggests that many single mature women are sexually active, physicians are often reluctant to discuss sexual matters with them. Structured and open‐ended interviews explored perceptions regarding mature women's sexuality and HIV‐related risk for patient‐physician communication among 44 ‘recently single’ mature women aged 45–68 and 31 primary care physicians. Age and ethnic group comparisons with the mature women suggest that younger and African‐American women reported higher HIV and STI risk perception than older and White women. Many mature women (64%) believed that they were at‐risk for HIV and STIs, whereas physicians considered younger patients most at‐risk and that risk declined with patients' advancing age and with female status. Mature women and physicians had different expectations regarding initiation of clinical sexual health discussions, with 44% of the mature women placing the onus of responsibility on the patient, whereas 74% of physicians believed it was the role of both doctors and patients to bring up these topics. The findings are instructive to primary care physicians and healthcare policy makers, indicating that sexual health issues are relevant to mature women's continued health and well‐being.     

Using disease risk estimates to guide risk factor interventions: field test of a patient workbook for self-assessing coronary risk

Objective To assess the feasibility and acceptability of a patient workbook for self‐assessing coronary risk. Design Pilot study, with post‐study physician and patient interviews. Setting and subjects Twenty southern Ontario family doctors and 40 patients for whom they would have used the workbook under normal practice conditions. Interventions The study involved convening two sequential groups of family physicians: the first (n=10) attended focus group meetings to help develop the workbook (using algorithms from the Framingham Heart Study); the second (n=20) used the workbook in practice with 40 patients. Follow‐up interviews were by interviewer‐administered questionnaire. Main outcome measures Physicians' and patients' opinions of the workbook's format, content, helpfulness, feasibility, and potential for broad application, as well as patients' perceived 10‐year risk of a coronary event measured before and after using the workbook. Results It took an average of 18 minutes of physician time to use the workbook: roughly 7 minutes to introduce it to patients, and about 11 minutes to discuss the results. Assessments of the workbook were generally favourable. Most patients were able to complete it on their own (78%), felt they had learned something (80%) and were willing to recommend it to someone else (98%). Similarly, 19 of 20 physicians found it helpful and would use it in practice with an average of 18% of their patients (range: 1–80%). The workbook helped to correct misperceptions patients had about their personal risk of a coronary event over the next 10 years (pre‐workbook (mean (SD) %): 35.2 (16.9) vs. post‐workbook: 17.3 (13.5), P < 0.0001; estimate according to algorithm: 10.6 (7.6)). Conclusions Given a simple tool, patients can and will assess their own risk of CHD. Such tools could help inform otherwise healthy individuals that their risk is increased, allowing them to make more informed decisions about their behaviours and treatment.     

The effectiveness of medical and vocational interventions for reducing sick leave of self‐employed workers

We investigate whether interventions by (a) medical doctors and (b) occupational specialists are effective in reducing sick leave durations among self‐employed workers. Therefore, we exploit unique administrative data comprising all sick leave claims by self‐employed workers insured with a major Dutch private insurer between January 2009 and March 2014. We estimate a multivariate duration model dealing with nonrandom selection into the two intervention types by controlling for observable and unobservable claimant characteristics. We find adverse treatment effects for both interventions, irrespective of whether they are started early or (middle) late in the sickness spell.     

Sexually transmitted infections and private physicians in Peru, 2003.

OBJECTIVES: To analyze demographic and practice characteristics of private physicians in 10 cities of Peru, and to shed light on the role of private practice in the delivery of medical care to patients with sexually transmitted infections (STIs). METHODS: As part of an interventional trial designed to improve physician management of STIs in 10 cities in Peru, detailed information was compiled regarding numbers of physicians in each city. A door-to-door survey was then conducted within each city of all private and public medical offices and institutions. Each physician encountered who had a private practice was asked to answer a questionnaire regarding demographic information, medical education, specialty, type of private and public practices currently engaged in, number of STI cases seen per month, and average earnings per consultation. RESULTS: Of 2,060 physicians working in the 10 cities, 507 reported having a private practice, either exclusively or concurrently with other clinical positions. Almost all the private physicians (97.4%) reported managing cases of STIs. Regional differences among private physicians were found in physician density, gender, and place of medical training. In addition, significant variations by gender were seen in rates of specialization, earnings per consultation, and numbers of female patients with STIs seen per month. CONCLUSIONS: Studies of the physician workforce can provide meaningful insights for potential use in addressing public health problems. This study provides valuable information that can help understand the important role of private physicians in managing STIs in Peru.     

Managing Care? Medicare Managed Care and Patient Use of Cardiologists

Objective. To examine the impact of Medicare managed care (MMC) versus Medicare fee for service (MFFS) on stent patients' use of physicians with lower resource use and better outcomes. Data Sources/Study Setting. Retrospective secondary data from 2003 through 2006 for 67,476 patients without acute myocardial infarction, staying 2 or more days in hospital, and treated by 486 physicians in Florida performing 10 or more cases per quarter. Study Design. Analysis was at the patient level. Multivariate logistic models estimated the probability of an MMC patient using a physician with a particular risk‐adjusted profile rank with respect to hospital peers. Principal Findings. No differences were found in usage of physicians with shorter admissions. Compared with MFFS, MMC patients were significantly less likely to use physicians whose average mortality was the lowest/lowest quartiles/below median among facility peers, and more likely to use a physician ranked below median on live discharges directly home (not needing home health care, skilled nursing care, or a subacute hospital convalescence). Similar results were found with emergency admissions, and where physicians both attended and treated. Conclusions. Florida percutaneous coronary interventions patients insured by MMC used physicians with worse outcome profiles than those of MFFS patients. Results were not consistent with hospital care differences, physician–patient, or payor–physician selection, but they were consistent with selection of unobservably sicker members into MMC and concentration of MMC among physicians.     

Physician participation in Medicaid: evidence from California.

The objective of this paper is to investigate physician participation in the Medicaid program. In particular, how sensitive is the physician''s involvement with Medicaid to variations in Medicaid reimbursements? How important are fee levels in the private market? What is the impact of inflation on the costs of physicians'' inputs, particularly if the Medicaid fee remains relatively constant? These questions are explored through an empirical analysis fo data from the California Medicaid program. Two aspects of physician participation form the focus of the study: 1) the percentage of physicians participating in Medicaid in a given county and 2) the average number of nonaged, Medicaid patients treated by each participating physician. Information on these variables and on Medicaid fees and private charges come from Medicare and Medicaid claims records for more than 3,000 physicians. The most significant result of the study is the reaffirmation of the importance of the amounts of both private charges and Medicaid payments in determining participation rates and average Medicaid case loads per participating physician. Both dependent variables are, as expected, inversely related to physicians'' average billed revenue per patient and are positively related to average Medicaid payments per patient. In addition, it appears that the long-run impact of a change in billed revenue is significantly larger in absolute value than a corresponding change in the amount that Medicaid is willing to pay.     

The significance of patients' perceptions of physician conduct

The provision of high quality medical care and the insurance of patient satisfaction depend in part upon the ability and willingness of physicians to establish rapport with their patients and to develop effective physician-patient communication. In this study, patients' overall satisfaction with their physicians' care was assessed in relation to their perceptions of their physicians' (1) proficiency at communicating and listening to details of the illness and medical treatment, (2) capability of providing affective care, and (3) technical competence. Perceptions of physician behaviors were measured by a questionnaire administered to 329 patients of 54 residents in a family practice center. The relationship between the perceptions of patients and their satisfaction with medical care was examined both for the entire sample and among groups of patients with differing demographic characteristics. Results indicate an important link between patients' perceptions of socioemotional aspects of the physician-patient relationship and their reported satisfaction with medical care. Noticeable differences were found to exist in the importance that patients with different demographic characteristics placed on various aspects of their physicians' conduct.     

An Investigation of Causes of Patient Satisfaction/Dissatisfaction with Physician Services

To provide the highest level of satisfaction, health care providers must control patients' expectations and perception of treatment quality. This study is designed to gain insight into the perception and attitudes of consumers toward physician services. It attempts to examine the satisfaction/dissatisfaction of patients in association with the cost and quality of medical care; interpersonal skills, copmetence and professional recognition of physicians; information provided and attention given by physicians; waiting time, physical facilities, and receptioninsts and nurses in the physicians office. Data was gathered using telephone interviews from a sample of 245 respondents. Factor analysis techniques in the SPSSX software package were used in data analysis. Findings indicated that there are generally favorable attitudes toward the quality of medical services, and that medical cost has secondary importance.     

Bleeding Hearts,Profiteers, or Both: Specialist Physician Fees in an Unregulated Market

This study shows that, in an unregulated fee‐setting environment, specialist physicians practise price discrimination on the basis of their patients' income status. Our results are consistent with profit maximisation behaviour by specialists. These findings are based on a large population survey that is linked to administrative medical claims records. We find that, for an initial consultation, specialist physicians charge their high‐income patients AU$26 more than their low‐income patients. While this gap equates to a 19% lower fees for the poorest patients (bottom 25% of the household income distribution), it is unlikely to remove the substantial financial barriers they face in accessing specialist care. There are large variations across specialties, with neurologists exhibiting the largest fee gap between the high‐income and low‐income patients. Several possible channels for deducing the patient's income are examined. We find that patient characteristics such as age, health concession card status and private health insurance status are all used by specialists as proxies for income status. These characteristics are particularly important to further practise price discrimination among the low‐income patients but are less relevant for the high‐income patients. Copyright © 2016 John Wiley & Sons, Ltd.     

Reliable,Silent, Hysterical,or Assured: in Their Medical Decision Making

This article examines how physicians interpret nonmedical cues from patients' behavior in order to decide how to communicate, treat, and diagnose. Data were drawn from a larger study of physician decision making in which physicians were asked to tell a story about a recent difficult decision. Five categories of patient cues interpreted by physicians were examined: physical condition, feelings about their medical condition, personality, attitude about medical care, and social background. Interpretation of these patient cues is an important way physicians develop guidelines for making and rationalizing decisions about how to communicate and care for patients.