The effect of physician self-disclosure on patient self-disclosure and patient perceptions of the physician

ObjectivesPhysician self-disclosure is typically seen as patient-centered communication because it creates rapport and is seen as an expression of empathy. Given that many physician behaviors affect patients differently depending on whether they are shown by a female or male physician, we set out to test whether physician self-disclosure affects patients’ intentions to self-disclose and patients’ perceptions of their physicians depending on physicians’ gender.MethodTwo hundred and forty-four participants were recruited and randomly assigned to read one of 4 vignettes as if they were the patient in the dialogue (analogue patient design). They were then asked to report how they would react to the physician and how they perceived the him or her.ResultsPhysicians who self-disclosed were perceived as more empathic than physicians who did not, regardless of physician and patient gender. Physician self-disclosure had an effect on the behavioral intentions of the analogue patients, and this was moderated by physician gender. Analogue patients indicated to be more willing to self-disclose to female than to male physicians who self-disclosed.ConclusionIt is important to consider physician gender when training physicians in patient-centered communication because the same behavior can have different effects on patients depending on whether it originates from a female or a male physician.Practical implicationsPhysicians can use self-disclosure to express empathy. When female physicians do so, they might obtain more personal information from patients, which can positively affect diagnosis and treatment.     

“Very humble” vs. “Not humble”: What do ratings of fictitious physician profiles with humility descriptors reveal about potential patient preferences and behaviors?

ObjectivesThe current study examined the impact of physician humility on future medical interactions and physician-related outcomes (e.g., patient patronage, loyalty) using a non-patient, community sample.MethodsParticipants (N = 417) were recruited online through Amazon Mechanical Turk (mTurk) and paid a nominal fee for their participation. They reviewed randomly assigned fictitious physician profiles that differed in humility (high, low), general effectiveness (high, low), physician gender (male, female), and specialty (family practice, orthopedic surgery). Then they reported their likelihood to trust, adhere to recommendations, and be satisfied with the physician. They also conveyed how likely they would select and recommend this physician to others, and how much out-of-pocket money they would be willing to spend to see the physician.ResultsHumble physicians were rated higher than their non-humble counterparts on all five outcomes. For physicians who were generally ineffective, the physicians low in humility scored lower on intended adherence, trust, and anticipated satisfaction than the physicians high in humility. Additionally, for physicians specializing in family practice, physicians low in humility scored lower on anticipated satisfaction and out-of-pocket expenditure than the physicians high in humility.ConclusionsFindings from this study highlight how physician humility can affect the process of care even before it begins.Practice ImplicationsThe study emphasizes the need for deliberate pursuit of humility to improve outcomes for patients and physicians.     

Physician gaze shifts in patient-physician interactions: functions,accounts and responses

ObjectivesPhysician gaze towards patients is fundamental for medical consultations. Physicians’ use of Electronic Health Records (EHR) affects their gaze towards patients, and may negatively influence this interaction. We aimed to study conversation patterns during gaze shifts of physicians from the patient towards the EHR.MethodsOutpatient consultations (N = 8) were eye-tracked. Interactions around physician gaze shifts towards the computer were transcribed.ResultsWe found that physician gaze shifts have different interactional functions, e.g., introducing a topic switch or entering data into the EHR. Furthermore, physicians differ in how they account for their gaze shifts, i.e., both implicitly and explicitly. Third, patients vary in treating the gaze shift as an indication to continue their turn or not.ConclusionsOur results suggest that physician gaze shifts vary in function, in how physicians account for them, and in how they influence the conversation. Future research should take into account distinctions when relating gaze to patient outcomes.Practice implicationsPhysicians may be aware of the interactional context of their gaze behaviour. Patients respond differently to various types of gaze shifts. How physicians handle gaze shifts can therefore have different consequences for the interaction.     

Disentangling physician sex and physician communication style: their effects on patient satisfaction in a virtual medical visit

OBJECTIVE: The present study aimed to investigate the effect of physician sex and physician communication style on patient satisfaction. In real medical visits, physician sex and physician communication style are confounded variables. By using the virtual medical visit paradigm, we were able to disentangle the two variables and study their separate and/or joint effects on patient satisfaction. METHOD: In an experimental design, analogue patients (167 students) interacted with a computer-generated virtual physician on a computer screen. The patients' satisfaction during the visit was assessed. RESULTS: Depending on the sex composition of the dyad, physician communication style affected analogue patients' satisfaction differently. For instance, in male-male dyads, physician communication style did not affect the patients' satisfaction, whereas in female-female dyads, analogue patients were more satisfied when the physician adopted a caring as opposed to a non-caring communication style. CONCLUSION: Sex of the physician and sex of the patient moderate how different physician communication styles affect patient satisfaction. In particular, a female-sex role congruent communication style leads to higher patient satisfaction when women see a female physician. PRACTICE IMPLICATIONS: Physician communication training cannot be one size fits all. Rather female and male physicians should obtain different training and they need to be made aware of the fact that female and male patients harbor different expectations toward them.     

The intersection of physician wellbeing and clinical application of diabetes guidelines

Objectives

Prediabetes (preDM) and diabetes are complex conditions that place significant strain on medical providers. This can have a negative impact on providers’ wellbeing and could impact clinical decisions. We investigated the interplay of caring for patients with prediabetes, physician mental wellbeing, and clinical care.

Impact of communication training on physician expression of empathy in patient encounters

Objective

To examine whether an educational intervention that focused on physician communication training influenced physician empathic expression during patient interactions.

Methods

This study used a quantitative research method to investigate the influence of communication training on physician-expressed empathy using two measures (global and hierarchical) of physician empathic behavior.

Results

The differences in global empathy scores in the physician training group from baseline to follow-up improved by 37%, and hierarchical scores of physician empathic expression improved by up to 51% from baseline scores for the same group.

Conclusions

The results strongly supported the hypotheses that training made a significant difference in physician empathic expression during patient interactions demonstrated by both outside observer measures of global ratings and hierarchical ratings of physician empathic behavior.

Practice implications

These findings have significant implications for program design and development in medical education and professional training with the potential to improve patient outcomes.     

Associations between thin slice ratings of affect and rapport and perceived patient-centeredness in primary care: Comparison of audio and video recordings

ObjectiveTo investigate associations between ratings of “thin slices” from recorded clinic visits and perceived patient-centeredness; to compare ratings from video recordings (sound and images) versus audio recordings (sound only).MethodsWe analyzed 133 video-recorded primary care visits and patient perceptions of patient-centeredness. Observers rated thirty-second thin slices on variables assessing patient affect, physician affect, and patient-physician rapport. Video and audio ratings were collected independently.ResultsIn multivariable analyses, ratings of physician positive affect (but not patient positive affect) were significantly positively associated with perceived patient-centeredness using both video and audio thin slices. Patient-physician rapport was significantly positively associated with perceived patient-centeredness using audio, but not video thin slices. Ratings from video and audio thin slices were highly correlated and had similar underlying factor structures.ConclusionPhysician (but not patient) positive affect is significantly associated with perceptions of patient-centeredness and can be measured reliably using either video or audio thin slices. Additional studies are needed to determine whether ratings of patient-physician rapport are associated with perceived patient-centeredness.Practice implicationsObserver ratings of physician positive affect have a meaningful positive association with patients’ perceptions of patient-centeredness. Patients appear to be highly attuned to physician positive affect during patient-physician interactions.     

Liking in the physician--patient relationship

Patients and physicians in established relationships (261 patients and their 44 physicians) were asked after a medical visit how much they liked each other and how much they felt liked, along with questions concerning patient health, physician and patient satisfaction, and the patient's affective state. Patients were re-contacted 1 year later and asked about their satisfaction with the same physician and whether they had considered changing physicians during the year. Patients' and physicians' ratings indicated mutuality of liking, as well as accuracy of estimating the other's liking for the self. The physician's liking for the patient was positively associated with the following variables: better patient health, more positive patient affective state after the visit, more favorable patient ratings of the physician's behavior, greater patient satisfaction with the visit, and greater physician satisfaction with the visit. The patient's liking for the physician was positively associated with better self-reported health, a more positive affective state after the visit, more favorable ratings of the physician's behavior, and greater visit satisfaction. Both the physician's liking for the patient and the patient's liking for the physician positively predicted the patient's satisfaction 1 year later and were associated with a lower likelihood that the patient considered changing physicians during the year. Female physicians reported liking their patients more than male physicians did, and patients' ratings of how much they felt liked corroborated this difference. Patients also reported liking female physicians more than male physicians. A number of these results remained significant even after controlling for the patient's overall satisfaction with the medical visit.     

Agreeable patient meets affiliative physician: How physician behavior affects patient outcomes depends on patient personality

Objective

This study tests whether the personality trait of agreeableness in simulated patients moderates their reactions to the physician's behavior. We predicted that the more agreeable the participants, the more positive the interaction outcomes when they see a high affiliative physician as compared to a low affiliative physician.

Methods

Participants (60 students) watched videotaped excerpts (2 min each) of 4 physicians exhibiting a high affiliative behavior and of 4 physicians exhibiting a low affiliative behavior. Participants reported after each physician their satisfaction, trust, determination to adhere to the treatment recommendations, and their perception of the physician's competence. They also completed the agreeableness scale of the NEO-PI-R personality questionnaire.

Results

The higher the agreeableness scores of the participants, the higher was their trust with the high affiliative physicians as compared to the low affiliative physicians, their perception of the physician's competence, and their determination to adhere to the treatment.

Conclusion

Results confirmed that the more agreeable the simulated patients were, the better they reacted to a physician behavior that was high rather than low in affiliativeness.

Practice implications

These results suggest that the more agreeable patients are, the more important it is that physicians adopt a high affiliative behavior.     

The physician and patient education: a review.

Education is an essential part of medical care and must be conducted properly for the patient to receive optimal benefit. Since physicians are responsible for a major portion of the health care delivered, there is a need to understand how patient education is used by these practitioners. Our current understanding of physician-patient education practices is reviewed in this paper. The frequency of patient education by physicians, the educational content and processes employed, and physician attitudes toward patient education are examined. This analysis shows that patient education is a salient issue among physicians. They report a high frequency of use of patient education with as many as 20% of visits containing a major educational intervention. The content of these interventions is weighed heavily toward instructions and information, with little assessment, monitoring or reinforcement noted. Physician attitudes toward patient education reflect an awareness of its importance and insecurity with actual educational interventions. A number of substantive issues remain to be addressed, including interventions to improve physician educational practice.     

Ethical principles for physician rating sites

During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites’ effects on physicians’ performance, patient outcomes, or the public’s trust in health care, most contributions refer to normative arguments, hypothetical effects, or indirect evidence. This paper aims, first, to structure the ethical debate about the basic concept of physician rating sites: allowing patients to rate, comment, and discuss physicians’ performance, online and visible to everyone. Thus, it provides a more thorough and transparent starting point for further discussion and decision making on physician rating sites: what should physicians and health policy decision makers take into account when discussing the basic concept of physician rating sites and its possible implications on the physician–patient relationship? Second, it discusses where and how the preexisting evidence from the partly related field of public reporting of physician performance can serve as an indicator for specific needs of evaluative research in the field of physician rating sites. This paper defines the ethical principles of patient welfare, patient autonomy, physician welfare, and social justice in the context of physician rating sites. It also outlines basic conditions for a fair decision-making process concerning the implementation and regulation of physician rating sites, namely, transparency, justification, participation, minimization of conflicts of interest, and openness for revision. Besides other issues described in this paper, one trade-off presents a special challenge and will play an important role when deciding about more- or less-restrictive physician rating sites regulations: the potential psychological and financial harms for physicians that can result from physician rating sites need to be contained without limiting the potential benefits for patients with respect to health, health literacy, and equity.     

Illness perceptions and negative responses from medical professionals in patients with fibromyalgia: Association with patient satisfaction and number of hospital visits

Objective

To examine whether illness perceptions among patients with fibromyalgia and negative responses from medical professionals correlate with their satisfaction with their physicians or with their number of hospital visits.

How female and male physicians’ communication is perceived differently

Objective

This paper is based on a 2017 Baltimore International Conference on Communication in Healthcare (ICCH) plenary presentation by the first author and addresses how female and male physicians' communication is perceived and evaluated differently. Female physicians use patient-centered communication which is the interaction style clearly preferred by patients. Logically, patients should be much more satisfied with female than male physicians. However, research shows that this is not the case.

Cancer screening adherence: Does physician–patient communication matter?

Objective

The objective of this study was to examine the separate contributions of patients and physicians to their communication regarding cancer screening.

Methods

Research design and subjects: The authors conducted a cross-sectional analysis of survey data collected from 63 community-based primary care physicians and 904 of their female patients in Los Angeles.

Results

Patients who perceived their physicians to be enthusiastic (at any level) in their discussions of mammography or fecal occult blood tests (FOBT) were significantly more likely to report a recent test than patients who reported no discussions.

Conclusion

Physician discussions of cancer screening are important and effective even when, as in the case of mammography, screening rates are already high, or, as in the case of FOBT, rates have tended to remain low. The value of communication about screening should be taught and promoted to primary care physicians who serve as gatekeepers to screening.

Practice implications

Those who train physicians in communication skills should take into account our finding that the communication style of physicians (e.g., enthusiasm for screening) was the only patient or physician variable that both influenced screening adherence and that could be taught.     

The role of patient education and physician support in self-efficacy for skin self-examination among patients with melanoma

ObjectiveThis project aims to elucidate the relationships between skin self-examination (SSE), perceived physician support of SSE, and self-efficacy for SSE among melanoma patients.MethodsA longitudinal study of patients diagnosed with melanoma was conducted over the span of 18 months. Participants filled out questionnaires at four assessment points and participated in an SSE education about the early signs of melanoma.ResultsAmong the 242 patients enrolled, the level of self-efficacy for SSE was 23% higher immediately after the educational intervention (p < .001) and the increase was retained three months (p < .001) and twelve months later (p < .001). Additionally, a one-way repeated measures ANOVA revealed that the perceived physician support of SSE positively corresponded to the level of patient self-efficacy with higher patient-reported physician support being related to higher self-efficacy (p = .001).ConclusionPatient education and perceived physician support of SSE are positively associated with patients’ level of self-efficacy.Practice implicationsPhysicians caring for melanoma survivors should be aware that, both SSE education and patients’ perception of high physician support of SSE may be associated with higher self-efficacy for checking one’s own skin for signs of cancer recurrence.     

Parent being a physician: Any influence upon job stress in young physicians? A Norwegian prospective and longitudinal cohort study

ObjectiveTo investigate whether being the child of a physician would be of importance for how young physicians experience job stress.MethodIn a national representative prospective and longitudinal study with five assessment points (NORDOC), young physicians were followed over twenty year after graduation from medical school.ResultsFemale physicians with a physician parent reported higher levels of job stress over the whole period compared with males with a physician parent. This gender difference did not occur within the group without a physician parent. Male young physicians showed a trend (not quite significant) to be less stressed than their peers without a physician parent. Women physicians were overrepresented in a group with persisting high stress level over the period.ConclusionsMale physicians with physician parent reporting lower stress levels than their female peers can be interpreted as a consequence of male physicians having more male models during their first working years as the main proportion of older physicians still are men. A father-son relationship may also promote an easier way to lower stress and achieve an identification with the role of doctor than for the females with a father-daughter relationship. With the increasing number of female physician, this gender difference may be prone to changes over time.     

The importance of physician listening from the patients' perspective: enhancing diagnosis, healing, and the doctor-patient relationship

ObjectiveThe research findings reported here describe the importance and various functions of physician listening according to patients.MethodsFifty-eight patients of the McGill University Health Centre were interviewed using a qualitative, interpretive design approach.ResultsPatients explained why listening was important to them and these findings were organized into three themes: (a) listening as an essential component of clinical data gathering and diagnosis; (b) listening as a healing and therapeutic agent; and (c) listening as a means of fostering and strengthening the doctor–patient relationship. The findings are presented along with a conceptual model on the functions of physician listening.ConclusionElucidating the multiple functions of listening in the clinical encounter from patient perspectives can assist physicians in improving their listening approach.Practice implicationsFor training purposes, we recommend that a module on listening should lead to a discussion not only about the skill required in listening attentively, but also to the values, beliefs, attitudes, and intentions of physicians who choose to listen to their patients. This teaching objective may be facilitated by future research that explores the concept of ‘authenticity’ in a physician's listening approach, which we argue is central to successful clinical outcomes.