Patient affect,physician liking for the patient,physician behavior,and patient reported outcomes: A modeling approach

ObjectiveTo determine associations between patient affect and physician liking of the patient, and their associations with physician behavior and patient-reported outcomes.MethodsStructural equation modeling based on coding of 497 videotaped hospital encounters, with questionnaires assessing pre-visit patient affect, post-visit patient affect and encounter evaluations, and physician liking of the patient, involving 71 physicians.ResultsIn first visits, patient reported outcomes were strongly correlated with physician behavior and less so with physician liking, while in later visits, patient reported outcomes were directly related to physician liking and not mediated by physician behavior. Physician liking predicted physician behavior, more for female physicians in first visits. Patient negative affect before the visit was negatively associated with male physicians’ liking. When acquainted, both patient positive and negative affect were associated with physician liking.ConclusionPhysician liking of the patient plays a dynamic role in a consultation, is influenced by patient pre-encounter affect, and influences physician behavior. The dynamics are different in first and later visits, and influenced by physician gender.Practice implicationsPhysicians should be aware how patient affect influences their behavior, and administrators should take any prior relationship between patient and physician into account when evaluating patient reported outcomes.     

Talking about depression: An analogue study of physician gender and communication style on patient disclosures

Objectives

To disentangle the effects of physician gender and patient-centered communication style on patients’ oral engagement in depression care.

Methods

Physician gender, physician race and communication style (high patient-centered (HPC) and low patient-centered (LPC)) were manipulated and presented as videotaped actors within a computer simulated medical visit to assess effects on analogue patient (AP) verbal responsiveness and care ratings. 307 APs (56% female; 70% African American) were randomly assigned to conditions and instructed to verbally respond to depression-related questions and indicate willingness to continue care. Disclosures were coded using Roter Interaction Analysis System (RIAS).

Results

Both male and female APs talked more overall and conveyed more psychosocial and emotional talk to HPC gender discordant doctors (all p < .05). APs were more willing to continue treatment with gender-discordant HPC physicians (p < .05). No effects were evident in the LPC condition.

Conclusions

Findings highlight a role for physician gender when considering active patient engagement in patient-centered depression care. This pattern suggests that there may be largely under-appreciated and consequential effects associated with patient expectations in regard to physician gender that these differ by patient gender.

Practice implications

High patient-centeredness increases active patient engagement in depression care especially in gender discordant dyads.     

Pre-consultation information about one’s physician can affect trust and treatment outcome expectations

ObjectiveInformation about physicians’ skills is increasingly available on the internet and consulted by patients. The impact of such information on patient expectations is largely unknown. The aim of the present study was to investigate whether information about the competence and empathic skills of a physician may impact pre-consultation trust and treatment outcome expectations in mild and severe medical conditions.MethodsIn this experimental web-based study, participants (n = 237) read vignettes describing competence and empathic skills (low versus high) of a fictive physician who would surgically remove a mole or melanoma (low versus high severity) following a 2 × 2 × 2 between-subjects design. Participants rated trust in the physician and treatment outcome expectations.ResultsHigh competence and empathy raised trust in the physician, regardless of condition severity. High competence and high empathy both also increased expected surgery success, while only high competence reduced expected side effects.ConclusionPre-consultation information highlighting a physician’s competence and/or empathy may lead to higher trust in that physician, higher expected surgery success, and lower expected side effects.Practice ImplicationsPhysicians and hospital staff should be aware of the effects of written information available and might, for example, provide profiles on hospital websites emphasizing healthcare providers’ competence and empathy.     

Physicians’ information seeking behavior in patients presenting with heart failure symptoms – Does gender of physician and patient matter?

ObjectiveTo examine differences in the anamnesis in heart failure patients by patient and physician gender.MethodsA factorial experimental design with video vignettes was applied. While the dialog of an initial encounter because of heart failure symptoms was identical in all videos, patients, played by professional actors, differed in terms of gender (male/female), age (55 years/75 years) and Turkish migration history (no/yes). After viewing the video, 128 physicians (50 % female) were asked if they wanted to ask additional questions (yes/no) and if so, what they wanted to ask (open ended). A coding frame was conducted for the open ended question.ResultsCompared to male physicians, female physicians more often said they wanted to ask additional questions, especially about psychosocial aspects. Physicians, particularly female physicians, wanted to ask male patients more often about lifestyle aspects compared to female patients.ConclusionAlthough the dialog was identical in all videos, some variations in the anamnestic approach regarding physician and patient gender were identified. This is in contrast to current heart failure guidelines that recommend a detailed anamnesis in all patients presenting themselves with heart failure symptoms.Practice ImplicationsPrimary care physicians should reflect how possible gender stereotypes may influence their anamnestic behavior.     

What is clinical empathy? Perspectives of community members,university students,cancer patients,and physicians

ObjectivesTo explore what undergraduates, community members, oncology patients, and physicians consider empathic behavior in a physician.Methods150 undergraduates, 152 community members, 95 physicians, and 89 oncology patients rated 49 hypothetical physician behaviors for how well they fit their personal definition of physician empathy. Dimensions of empathy were explored and compared across groups.ResultsThree dimensions of empathy were Conscientious and Reassuring, Relationship Oriented, and Emotionally Involved. Relationship Oriented was the most strongly endorsed, followed by Emotionally Involved, with Conscientious and Reassuring coming in last. There were no group differences for Conscientious and Reassuring, but the Relationship Oriented factor was more endorsed by the clinical groups (physicians and patients) than the non-clinical groups. The Emotionally Involved factor was endorsed by physicians notably more than by patients.ConclusionWhat is considered clinical empathy is not the same across individuals and stakeholder groups.Practice ImplicationsPhysicians and patients differ in how much they include the physicians’ emotionality and emotion-related actions in their definition of empathy. Communication training for physicians that emphasizes behaviors associated with empathy (listening, understanding a person’s feelings and perspectives, and showing interest in and concern for the whole person) may enhance patients’ perception of clinical empathy.     

Physician gender,physician patient-centered behavior,and patient satisfaction: A study in three practice settings within a hospital

Objective

To compare male and female physicians on patient-centeredness and patients’ satisfaction in three practice settings within a hospital; to test whether satisfaction is more strongly predicted by patient-centeredness in male than female physicians.

Methods

Encounters between physicians (N = 71) and patients (N = 497) in a hospital were videotaped and patients’ satisfaction was measured. Patient-centeredness was measured by trained coders.

Results

In the outpatient setting, female physicians were somewhat more patient-centered than male physicians; patient satisfaction did not differ. In the inpatient and emergency room settings, female physicians were notably more patient-centered than male physicians; satisfaction paralleled these differences. Nevertheless, there was some, though mixed, evidence that patient-centeredness predicted satisfaction more strongly in male than female physicians, suggesting that patients valued patient-centered behavior more in male than female physicians.

Conclusion

Even though satisfaction mirrored the different behavior styles of male and female physicians in the inpatient and emergency room settings, in all settings male physicians got somewhat more credit for being patient-centered than female physicians did.

Practice implications

If female physicians do not consistently receive credit for high patient-centeredness in the eyes of patients, this could lead female physicians to reduce their patient-centered behavior.     

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.

PHYSICIAN CHARACTERISTICS THAT INFLUENCE PATIENT PARTICIPATION IN THE TREATMENT OF PRIMARY IMMUNODEFICIENCY

ObjectiveShared decision making (SDM) is recommended to improve healthcare quality. Physicians who use a rational decision-making style and patient-centric approach are more likely to incorporate SDM into clinical practice. This paper explores how certain physician characteristics such as gender, age, race, experience, and specialty explain patient participation.MethodsA multi-group structural equation model tested the relationship between physician decision-making styles, patient-centered care, physician characteristics, and patient participation in clinical treatment decisions. A survey was completed by 330 physicians who treat primary immunodeficiency. Sample group responses were compared between groups across specialty, age, race, experience, or gender.ResultsA patient-centric approach was the main factor that encouraged SDM independent of physician decision-making style with both treatment protocols and product choices. The positive effect of patient-centrism is stronger for immunologists, more experienced physicians, or male physicians. A rational decision-making style increases participation for non-immunologists, older physicians, white physicians, less-experienced physicians and female physicians.ConclusionA patient-centric approach, rational decision-making and certain physician characteristics help explain patient participation in clinical decisions.Practice ImplicationsFuture SDM research and policy initiatives should focus on physician adoption of patient-centric approaches to chronic care diseases and the potential bias associated with physician characteristics and decision-making style.     

Physician experience is associated with greater underestimation of patient pain

ObjectiveProcedural pain is unique in that physicians simultaneously cause and assess it. Experienced male physicians are known to underestimate their female patients’ pain more than other physicians. However, it is unknown whether this also occurs in obstetrics/gynecology, where all patients are females. This study addresses the gap in literature on procedural pain assessment accuracy.MethodsThe present research compares paired pain evaluations from 20 obstetricians/gynecologists and their 92 female patients.ResultsOur data demonstrate that patients’ reported pain levels (M = 5.53, SD = 2.7) were significantly higher than their physicians’ pain estimates (M = 4.89, SD = 2.19), t = 2.64, p < 0.005. The gap between patients’ and physicians’ pain estimates was greatest among physicians with the greatest procedural experience (M = 1.49, SD = 2.24), f = 5.72, p < 0.005. Male physicians underestimated their patients’ pain significantly more than female physicians do, t = 2.27, p < 0.05.ConclusionOur results shed light on systematic underestimation of procedural pain and highlight the significance of experience and sex differences in pain evaluation.Practice implicationsPhysicians’ experience influences their perception of patient pain while performing procedures. Experienced male physicians, even those who exclusively treat female patients, need to be aware of this ubiquitous bias in assessing their female patients’ procedural pain.     

“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.     

Identifying transparency in physician communication

Objective

To categorize physician communication demonstrating understanding of what patients want to know and skill in conveying that information. Physicians underestimate how much information patients want and patients rarely seek information during clinic visits. Transparent communication is advocated to facilitate patient understanding and support autonomy, informed decision-making and relationship development.

Methods

Analysis and coding of 263 audiotaped interactions between 33 primary care physicians and their patients in eight community-based, primary care clinics in Washington State, USA.

Results

Physicians proactively used five types of process transparency to preview speech and actions. Four types of content transparency were used to explicate diagnosis and treatment, demystify medical language and concepts, and interpret biomedical information. Physicians spent the greatest proportion of clinic time explicating medical content.

Conclusion

The primacy of information exchange over process-oriented, relational communication was demonstrated. Proactive transparency appears promising to increase understanding and collaboration.

Practice implications

In patient-centered care where collaboration is the ideal, transparency in its various forms is a critical ingredient. Without much communicative effort, physicians who proactively communicated that an examination was over, that they were leaving the exam room briefly so patients could dress provided information that appeared to address patient uncertainty and demonstrated empathy and respect.     

Are physicians’ attitudes of respect accurately perceived by patients and associated with more positive communication behaviors?

ObjectiveTo explore the domain of physician-reported respect for individual patients by investigating the following questions: How variable is physician-reported respect for patients? What patient characteristics are associated with greater physician-reported respect? Do patients accurately perceive levels of physician respect? Are there specific communication behaviors associated with physician-reported respect for patients?MethodsWe audiotaped 215 patient–physician encounters with 30 different physicians in primary care. After each encounter, the physician rated the level of respect that s/he had for that patient using the following item: “Compared to other patients, I have a great deal of respect for this patient” on a five-point scale between strongly agree and strongly disagree. Patients completed a post-visit questionnaire that included a parallel respect item: “This doctor has a great deal of respect for me.”Audiotapes of the patient visits were analyzed using the Roter Interaction Analysis System (RIAS) to characterize communication behaviors. Outcome variables included four physician communication behaviors: information-giving, rapport-building, global affect, and verbal dominance. A linear mixed effects modeling approach that accounts for clustering of patients within physicians was used to compare varying levels of physician-reported respect for patients with physician communication behaviors and patient perceptions of being respected.Results: Physician-reported respect varied across patients. Physicians strongly agreed that they had a great deal of respect for 73 patients (34%), agreed for 96 patients (45%) and were either neutral or disagreed for 46 patients (21%). Physicians reported higher levels of respect for older patients and for patients they knew well. The level of respect that physicians reported for individual patients was not significantly associated with that patient's gender, race, education, or health status; was not associated with the physician's gender, race, or number of years in practice; and was not associated with race concordance between patient and physician.While 45% of patients overestimated physician respect, 38% reported respect precisely as rated by the physician, and 16% underestimated physician respect (r = 0.18, p = 0.007). Those who were the least respected by their physician were the least likely to perceive themselves as being highly respected; only 36% of the least respected patients compared to 59% and 61% of the highly and moderately respected patients perceived themselves to be highly respected (p = 0.012). Compared with the least-respected patients, physicians were more affectively positive with highly respected patients (p = 0.034) and provided more information to highly and moderately respected patients (p = 0.018).ConclusionPhysicians’ ratings of respect vary across patients and are primarily associated with familiarity rather than sociodemographic characteristics. Patients are able to perceive when they are respected by their physicians, although when they are not accurate, they tend to overestimate physician respect. Physicians who are more respectful towards particular patients provide more information and express more positive affect in visits with those patients.Practice implicationsPhysician respectful attitudes may be important to target in improving communication with patients.     

Effects of counseling techniques on patients' weight-related attitudes and behaviors in a primary care clinic

ObjectiveExamine primary care physicians’ use of counseling techniques when treating overweight and obese patients and the association with mediators of behavior change as well as change in nutrition, exercise, and weight loss attempts.MethodsWe audio recorded office encounters between 40 physicians and 461 patients. Encounters were coded for physician use of selected counseling techniques using the Motivational Interviewing Treatment Integrity (MITI) scale. Patient motivation and confidence as well as Fat and Fiber Diet score (1–4), Framingham physical activity questionnaire (MET-minutes), and weight loss attempts (yes/no) were assessed by surveys. Generalized linear models were fit, including physician, patient, and visit level covariates.ResultsPatients whose physicians were rated higher in empathy improved their Fat and Fiber intake 0.18 units (95% CI 0, 0.4). When physicians used “MI consistent” techniques, patients reported higher confidence to improve nutrition (OR 2.57, 95% CI 1.2, 5.7).ConclusionWhen physicians used counseling techniques consistent with MI principles, some of their patients’ weight-related attitudes and behaviors improved.Practice implicationsPhysicians may not be able to employ formal MI during a clinic visit. However, use of counseling techniques consistent with MI principles, such as expression of empathy, may improve patients’ weight-related attitudes and behaviors.     

The interactive effects of counselor gender,physical attractiveness and status on client self-disclosure

Investigated client self-disclosure and client perception of counselors (as expressed in counselor evaluations) as a function of the sex, attractiveness and status of the counselor, and the sex of the client. Counselor gender and attractiveness were established by means of stimulus photographs; counselor status was defined in terms of education and experience. Ss (160 college students) first rated their counselors on intelligence and empathy; they then completed Jourard's Self-Disclosure Questionnaire while role-playing clients in therapy. A four-factor between-Ss analysis of disclosure scores revealed that clients disclosed more of themselves to male than to female counselors when the counselors were high in either status or attractiveness. Results supported the hypothesis that the effect of counselor gender on client disclosure depends on an interaction of counselor gender with other counselor variables.     

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.     

Using crowdsourced analog patients to provide feedback on physician communication skills

ObjectiveEffective physician-patient communication is important, but physicians who are seeking to improve have few opportunities for practice or receive actionable feedback. The Video-based Communication Assessment (VCA) provides both. Using the VCA, physicians respond to communication dilemmas depicted in brief video vignettes; crowdsourced analog patients rate responses and offer comments. We characterized analog patients’ comments and generated actionable recommendations for improving communication.MethodsPhysicians and residents completed the VCA; analog patients rated responses and answered:“What would you want the provider to say in this situation?” We used qualitative analysis to identify themes.ResultsForty-three participants completed the VCA; 556 analog patients provided 1035 comments. We identified overarching themes (e.g., caring, empathy, respect) and generated actionable recommendations, incorporating analog patient quotes.ConclusionWhile analog patients’ comments could be provided directly to users, conducting a thematic analysis and developing recommendations for physician-patient communication reduced the burden on users, and allowed for focused feedback. Research is needed into physicians’ reactions to the recommendations and the impact on communication.Practice implicationsPhysicians seeking to improve communication skills may benefit from practice and feedback. The VCA was designed to provide both, incorporating the patient voice on how best to communicate in clinical situations.