Physician-patient communication following invasive procedures: an analysis of post-angiogram consultations

Although rarely studied, physician-patient interactions immediately following diagnostic tests are significant medical events because during these encounters the physician and patient often make decisions about major and sometimes invasive treatment. This investigation analyzed patterns of physician-patient communication following coronary angiography with particular attention to behaviors important to decision-making: physician information-giving, physician use of partnership-building, and active forms of patient participation (e.g., asking questions, being assertive, expressing concerns). We were particularly interested in effects related to the patient's race in light of documented evidence of racial disparities in cardiac care and outcomes. From audiotape recordings, 93 physician-patient interactions after coronary angiogram in a catheterization laboratory in a large US Veterans Affairs Medical Center were coded to measure the frequency of physicians' information-giving and partnership-building and the frequency of active patient participation. We also stratified these behaviors according to whether the behavior was prompted (e.g., physician information in response to a patient's question; a patient's opinion solicited by the doctor) or self-initiated. Several findings were noteworthy. First, these interactions were very brief and dominated by the physician. Second, although physician information-giving increased with more active patient participation, which in turn was correlated with physicians' use of partnership-building, proportionally little of the physicians' information (8%) and active patient participation (9%) was directly prompted by the other interactant. Finally, there was a tendency for physicians to self-initiate less information giving to black patients and for black patients to self-initiate less active participation than white patients. Although these differences were attenuated when other variables (e.g., the physician's training, disease severity) were included in the analysis, the pattern suggests a potential cycle of passivity where certain patients tend to receive fewer informational resources and these patients in turn do less to prompt the doctor for more.     

A comparison of methods for measuring patient satisfaction with consultations in primary care

BACKGROUND: Attention needs to be paid to comparing and standardizing methodsfor measuring patient satisfaction with consultations in primarycare. OBJECTIVES: To compare the Medical Interview Satisfaction Scale (MISS) andthe Consultation Satisfaction Questionnaire (CSQ) in terms ofacceptability, distribution of responses, reliability and gatherevidence of validity. In addition, to compare the scores ofpatients completing the questionnaires immediately after theconsultation in the general practitioners' surgeries with thosecompleting the questionnaires later at home. METHODS: The two questionnaires were bound as a single instrument withorder determined at random. This was given to patients immediatelyafter their consultations in eight practices in South Glamorgan. RESULTS: One hundred and ninety-eight of 316 (63%) patients completedand returned questionnaires. The distributions of patient satisfactionscores for the two questionnaires were very similar. For theMISS: mean 76.7% (SD 11.4); for the CSQ mean 77.2% (SD 12.6).Correlations between sub-scales ranged from 0.58–0.84for the MISS and from 0.40–0.79 for the CSQ. The correlationbetween the overall scales was 0.82. Levels of reliability forthe scales and sub-scales were fair to good ranging from 0.78-0.96for the MISS and from 0.73–0.94 for the CSQ. CONCLUSIONS: The study does not identify one scale as being superior in pyschometricterms, however by demonstrating consistency of responses itprovides support for the scales as measures of patient satisfactionfor use in primary care. The level of inter-correlation suggeststhat the sub-scales may not be clearly independent of each otherand suggests that total scores may be preferred. Lower levelsof satisfaction are expressed if patients complete questionnairesat home rather than in general practitioners' surgeries. Keywords. Satisfaction, primary care, psychometric testing.     

Gender differences in physicians' communicative skills and their influence on patient satisfaction in gynaecological outpatient consultations

As previous research has displayed, a physician's communication style is an essential factor predicting patient satisfaction and compliance. Furthermore, a good physician-patient relationship and high communication quality seem to be crucial elements fostering the activation of patients' self-healing powers. Due to their intimate nature, gynaecological health issues require specific adapted communicative skills. Several studies in primary care reveal gender differences in physicians' communication style. However, controversial findings have been reported in the field of obstetrics and gynaecology. The aim of the present study was to determine whether the expected gender differences in gynaecologists' communicative skills affect patient satisfaction and compliance. We analysed 196 videotapes of 30 real-life and 166 simulated (standardised) patient consultations in four different gynaecological outpatient settings with 13 male and 36 female gynaecologists from the University Hospital of Basel, Switzerland. Communicative skills were analysed by independent raters with the Revised Maastricht History-Taking and Advice Checklist (MAAS-R). All patients assessed their satisfaction after the consultation using the patient satisfaction questionnaire. Patients were more satisfied with female gynaecologists regarding the relationship and the consultation process, whereas the expected compliance was not related to physician gender. However, regression analyses demonstrated that it is not the gender of the physician but gender-related specific communicative skills -- mainly patient-centred communication -- that seem to be the crucial factor influencing patient satisfaction and likewise compliance. Hence, further research should be carried out on how these skills could be improved through specific training.     

Telehealth consultations in rheumatology: cost-effectiveness and user satisfaction

We conducted a feasibility study to assess user satisfaction with and the cost-effectiveness of a rheumatology telehealth clinic in northern Alberta. Six telehealth clinics were organized between a rural health centre and the specialist rheumatology centre, which was about a 4 h drive away. Fifty-two new patients were seen. Their median age was 54 years (range 7-81 years). After the teleconsultation, no patient required a conventional face-to-face consultation. Overall, patients agreed that the teleconsultation met their needs and that the care they received was as good as conventional care. The physicians involved in the study thought the process practical and effective. The total costs of service delivery would be equal for teleconsultation and for traditional consultation at a workload of 247 consultations a year.     

Doctor-patient communication in general practice consultations.

Detailed study of a series of tape-recorded interviews enabled the author to carry out a critical self-audit of his consultations. The analysis of categories of verbal interaction in doctor-patient consultations proved to be a practical and reliable method of studying the doctor-patient relationship. The methods and techniques used in this research could, with advantage, be employed in the fields of undergraduate and postgraduate teaching. Since a satisfactory doctor-patient relationship is of great value, study in depth of the verbal interaction between doctor and patient in general practice consultations can provide guide lines to those who seek an improvement in doctor-patient communication.     

Verbal communication skills and patient satisfaction. A study of doctor-patient interviews

This research attempted to quantify specific behaviors in the physician's initial interviewing style and relate them to patients' perception of satisfaction. Five physicians were tape recorded during their initial interviews with 52 adult patients. The patients were asked to complete the Medical Interview Satisfaction Scale, a 29-item instrument with a 7-point response scale. These interviews were transcribed, timed, coded, and analyzed with the use of the Computerized Language Analysis System. Selected variables of the language dimensions were entered as the predictor variables in a multiple regression, along with satisfaction scores as the dependent variables. Twenty-seven percent of the variance (p less than .01) in the satisfaction scores of initial interviews were explained by three aspects of a physician's language style: (a) use of silence or reaction time latency between speakers in an interview, (b) whether there was language reciprocity as determined through the reciprocal use of word-lists, and (c) the reflective use of interruptions within an interview. Considering the complexity of human communication, the fact that three variables were identified, which accounted for 27% of the variance in patients' satisfaction, is considered a substantial finding.     

A correlates of peer, supervisor, and patient communication effectiveness satisfaction

Using a sample of 200 medical technologists over a 4-year period, this study investigated whether peer, supervisor, and patient communication satisfaction facets were related but distinct referents. Confirmatory factor analyses on the medical technologist sample and a second independent sample of 85 medical/health professionals supported the distinctiveness of these three referents. Correlational differences between communication satisfaction referents were found. Specifically, professional withdrawal intent, gathered twice before communication satisfaction, had stronger negative relationships to patient versus peer communication satisfaction. Job satisfaction and organizational withdrawal intent also exhibited correlational differences to communication satisfaction referents. One unexpected finding across both samples was that there was higher communication satisfaction with patients of the opposite versus same sex.     

Focus of doctor-patient communication in follow-up consultations for patients treated surgically for colorectal cancer

A series of consultations between patients treated surgically for colorectal cancer and their hospital consultants were examined to establish the main focus of the consultation at various stages in the post-surgical period. The results showed that follow-up consultations were predominantly doctor driven. Patients interviewed less than 12 months since the time of surgery (short-term group) were more likely to receive a longer consultation with a significantly higher number of verbal interactions (questions, responses) than patients more than 12 months since surgery at the time of interview (long-term group). Furthermore, patients in the short-term group played a greater participatory role within consultations than patients in the long-term group. The predominant focus throughout all consultations was biomedical, with little attention afforded to patients' expressions of post-operative anxiety. At present, it appears that out-patient consultations play a minimal role in either detecting or addressing psychosocial morbidity amongst colorectal cancer patients in the post-surgical period.     

Physician-patient communication in the primary care office: a systematic review

BACKGROUND: The physician-patient interview is the key component of all health care, particularly of primary medical care. This review sought to evaluate existing primary-care-based research studies to determine which verbal and nonverbal behaviors on the part of the physician during the medical encounter have been linked in empirical studies with favorable patient outcomes. METHODS: We reviewed the literature from 1975 to 2000 for studies of office interactions between primary care physicians and patients that evaluated these interactions empirically using neutral observers who coded observed encounters, videotapes, or audiotapes. Each study was reviewed for the quality of the methods and to find statistically significant relations between specific physician behaviors and patient outcomes. In examining nonverbal behaviors, because of a paucity of clinical outcome studies, outcomes were expanded to include associations with patient characteristics or subjective ratings of the interaction by observers. RESULTS: We found 14 studies of verbal communication and 8 studies of nonverbal communication that met inclusion criteria. Verbal behaviors positively associated with health outcomes included empathy, reassurance and support, various patient-centered questioning techniques, encounter length, history taking, explanations, both dominant and passive physician styles, positive reinforcement, humor, psychosocial talk, time in health education and information sharing, friendliness, courtesy, orienting the patient during examination, and summarization and clarification. Nonverbal behaviors positively associated with outcomes included head nodding, forward lean, direct body orientation, uncrossed legs and arms, arm symmetry, and less mutual gaze. CONCLUSION: Existing research is limited because of lack of consensus of what to measure, conflicting findings, and relative lack of empirical studies (especially of nonverbal behavior). Nonetheless, medical educators should focus on teaching and reinforcing behaviors known to be facilitative, and to continue to understand further how physician behavior can enhance favorable patient outcomes, such as understanding and adherence to medical regimens and overall satisfaction.     

Effects of patient demands on satisfaction with Japanese hospital care.

OBJECTIVE: The objective of this study was to detect whether there was any difference among the characteristics of patient satisfaction between two patient emphasis groups: patients demanding technical elements of hospital care and patients demanding interpersonal elements. DESIGN AND SETTING: The sample for this study was drawn from in-patients discharged from 77 voluntarily participating hospitals throughout Japan. The relationship between overall satisfaction with hospital care and patient satisfaction, and the evaluation of a hospital's reputation, was explored by stepwise multiple regression analysis of 33 variables relevant to aspects of hospital care for each patient group. RESULTS: In the interpersonal emphasis (IE) group, 'nurse's kindness and warmth' was associated significantly with overall satisfaction, while 'skill of nursing care' and 'nurse's explanation' were significant predictors of overall satisfaction in the technical emphasis (TE) group. On the other hand, 'doctor's clinical competence', 'recovery from distress and anxiety', and items pertaining to the hospital's reputation were significantly related to overall satisfaction in both emphasis groups. CONCLUSION: For overall patient satisfaction, it is essential to satisfy specific items related to the aspect of hospital care emphasized by the patient. Specific significant predictors of overall satisfaction (e.g. 'doctor's clinical competence') were indispensable measures of professional performance in hospital care, irrespective of the patients' emphasis. A positive perception of hospital reputation items might increase overall patient satisfaction with Japanese hospitals.     

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.     

Listening to women's narratives of breast cancer treatment: a feminist approach to patient satisfaction with physician-patient communication

Traditional health communication research often has ignored sex and gender and has employed a quantitative biomedical perspective to predict behavior. In contrast, this study analyzed women's narratives of their breast cancer treatment to uncover conceptualizations of patient satisfaction with physician-patient communication. In their unfolding (nonlinear) narratives, patients viewed satisfaction as a negotiation process with physicians in which themes of respect, caring, and reassurance of expertise were prominent. Two root themes (dialogic approach to power and contextualization) acted as underlying dynamics or tensions throughout their narratives. Patients' ways of knowing and preferences for feminine communication styles influenced perceptions of physician-patient communication satisfaction.     

Physician-patient discussions of controversial cancer screening tests

BACKGROUND: Screening mammography for younger women and prostate-specific antigen (PSA) measurement have controversial benefits and known potential adverse consequences. While providing informed consent and eliciting patient preference have been advocated for these tests, little is known about how often these discussions take place or about barriers to these discussions. METHODS: We administered a survey to medical house staff and attending physicians practicing primary care. The survey examined physicians' likelihood of discussing screening mammography and PSA testing, and factors influencing the frequency and quality of these discussions. RESULTS: For the three scenarios, 16% to 34% of physicians stated that they do not discuss the screening tests. The likelihood of having a discussion was significantly associated with house staff physicians' belief that PSA screening is advantageous; house staff and attending physicians' intention to order a PSA test, and attending physicians' intention to order a mammogram; and a controversial indication for screening. The most commonly identified barriers to discussions were lack of time, the complexity of the topic, and a language barrier. CONCLUSIONS: Physicians report they often do not discuss cancer screening tests with their patients. Our finding that physicians' beliefs and intention to order the tests, and extraneous factors such as time constraints and a language barrier, are associated with discussions indicates that some patients may be inappropriately denied the opportunity to choose whether to screen for breast and prostate cancer.     

Perceptions of provider communication and patient satisfaction for treatment of acute low back pain

OBJECTIVE: We sought to assess the relationship between perceptions of provider communication and treatment satisfaction for acute, work-related low-back pain (LBP). METHODS: In a prospective cohort study, 544 working adults (67% men) with acute LBP provided 1- and 3-month assessments of pain, function, and work status. RESULTS: In a multiple regression analysis, positive provider communication (took problem seriously, explained condition clearly, tried to understand my job, advised to prevent re-injury) explained more variation in patient satisfaction at 1 month than was explained by clinical improvements in pain and function. At 3 months, clinical improvement variables surpassed provider communication as predictors of patient satisfaction. CONCLUSIONS: Patients with work-related LBP place a high value on provider counseling and education, especially during the acute stage (<1 month) of treatment.