Do patients talk differently to male and female physicians? A meta-analytic review

A meta-analytic review was undertaken of seven observational studies which investigated the relation between physician gender and patient communication in medical visits. In five of the studies the physicians were in general practice, internal medicine, or family practice and were seeing general medical patients, and in two of the studies the physicians were in obstetrics-gynecology and were seeing women for obstetrical or gynecological care. Significant findings revealed that, overall, patients spoke more to female physicians than to male physicians, disclosed more biomedical and psychosocial information, and made more positive statements to female physicians. Patients also were rated as more assertive toward female physicians and tended to interrupt them more. Several results were weaker, or even reversed, in the two obstetrics-gynecology studies. Partnership statements were made significantly more often to female than male physicians in general medical visits but not in obstetrical-gynecological visits.     

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.     

Tailoring the orthopaedic consultation: How perceived patient characteristics influence surgeons’ communication

Objective

To investigate whether and how orthopaedic surgeons tailor communication during medical consultations based on perceived patient characteristics.

Breast cancer patients’ trust in physicians: The impact of patients’ perception of physicians’ communication behaviors and hospital organizational climate

ObjectiveTo examine whether patients’ perception of a hospital's organizational climate has an impact on their trust in physicians after accounting for physicians’ communication behaviors as perceived by the patients and patient characteristics.MethodsPatients undergoing treatment in breast centers in the German state of North Rhein-Westphalia in 2006 were asked to complete a standardized postal questionnaire. Disease characteristics were then added by the medical personnel. Multiple linear regressions were performed.Results80.5% of the patients responded to the survey. 37% of the variance in patients’ trust in physicians can be explained by the variables included in our final model (N = 2226; R² adj. = 0.372; p < 0.001). Breast cancer patients’ trust in their physicians is strongly associated with their perception of a hospital's organizational climate. The impact of their perception of physicians’ communication behaviors persists after introducing hospital organizational characteristics. Perceived physician accessibility shows the strongest association with trust.ConclusionsA trusting physician–patient relationship among breast cancer patients is associated with both the perceived quality of the hospital organizational climate and perceived physicians’ communication behaviors.Practice implicationsWith regard to clinical organization, efforts should be put into improving the organizational climate and making physicians more accessible to patients.     

The value of physicians’ affect-oriented communication for patients’ recall of information

ObjectiveThe aim of this paper is to discuss experimental research investigating the effect of physicians’ affect-oriented communication on patients’ recall of information provided during medical consultations, with a special focus on the mediating role of emotional stress in that relation.Methods & resultsA search of experimental research literature was conducted, resulting in six research articles experimentally investigating the relations of interest, all using a video-vignettes design. A summary of results is provided and discussed.ConclusionsThe research reviewed in this paper provides evidence for the causal and mostly positive influence of several forms of affect-oriented communication on patients’ recall of medical information. Results indicate that reducing emotional stress may not be the underlying mechanism through which physicians’ communication influences patients’ recall.Practice implicationsThe obtained insights will help educators to teach evidence-based medical communication skills and to scientifically validate the importance of these skills for patients’ recall of information. Advancing physicians’ communication skills with evidence-based training will contribute to the professionalism that is the hallmark of good quality of care.     

How stable is perceived direction of gravity over extended periods in darkness?

Previous studies reported linear drift of perceived vertical for brief (≤10 min) observation periods. Here, we repeated estimates of direction of gravity up to 60 min to evaluate whether the drift is sustained, shows saturation or even reverses over time. Fifteen healthy human subjects repetitively adjusted a luminous line along subjective visual vertical (SVV) and horizontal (SVH) over periods of 5 min (constituting one block). We obtained seven blocks within 60 min in each subject for SVV and SVH. In between the first six blocks, subjects remained in darkness for 5 min each, whereas the lights were briefly turned on before block 7. We noted significantly (p < 0.05) increased errors in perceived direction of gravity by block 2 (SVV) and 3 (SVH). These increases disappeared after turning on the lights before block 7. Focusing on blocks 2–6, significant drift started from similar offset positions and pointed to the same direction in a majority of runs in 9/15 (SVV) and 11/15 (SVH) subjects. When pooling data from all blocks, orthogonality of errors was lost in all subjects. Trial-to-trial variability remained stable over the seven runs for SVV and SVH. Only when pooling all runs, precision was significantly (p < 0.05) higher for the SVH. Our findings suggest that perceived direction of gravity continues to fluctuate over extended recording periods with individuals showing unique patterns of direction-specific drift while variability remains stable. As subjects were upright during the entire experiment and as drift persisted over several blocks, sensory adaptation seems unlikely. We therefore favor a central origin of this kind of drift.     

What do clinicians expect? Comparing envisioned and reported violence for male and female patients

Mental health professionals' (MHPs') accuracy in assessing the risk of violence in female patients is particularly limited. Based on assessments made by 205 MHPs of 605 patients in an emergency room, this study explored potential causes of MHPs' poorer accuracy in assessing women's potential for violence. The dimensions that underlie MHPs' envisioned violence in patients were identified and were compared with those that characterized patients' reported violence during a 6-month follow-up period. There were three key findings from their study. First, violence envisioned by MHPs differed depending on their professional role and varied in its congruence with patients' reported violence. Second, patients' violence was organized by dimensions of domesticity and substance relatedness; women's violent incidents were more domestic than were men's. Third, when MHPs envisioned violence that was highly conditional on psychiatric deterioration and medication noncompliance, violence often did not occur.     

How organ-specific is the migration of ‘naive’ and ‘memory’ T cells?

The concept that ‘naive’ T cells (CD4⁺CD45RA^hi) selectively migrate into lymphoid organs and ‘memory’ T cells (CD4⁺CD45R0^hi) migrate into nonlymphoid organs has been enthusiastically taken up by the scientific community. However, even today, this premise is based mainly on indirect evidence obtained in one species. Here, Jürgen Westermann and Reinhard Pabst argue that, in the light of recent data, the generalization of this concept was too early.     

How is complementary medicine discussed in oncology? Observing real-life communication between clinicians and patients with advanced cancer

ObjectiveThis study aims to examine the structure of communication about complementary medicine (CM) between patients with cancer and clinicians during oncology consultations.MethodsPreviously, consultations between 29 clinicians and 80 patients with advanced cancer were recorded in six hospitals in the Netherlands. The present study considers a secondary analysis. References to CM during the consultation were coded using a self-developed observational coding scheme.ResultsAt least one reference to CM was observed in 35 out of 80 consultations (44 %), with a total of 73 references. In most cases, CM was initially referred to by patients. Clinicians often did not elaborate on the subject of CM. Relevant aspects related to CM (e.g., safety, effectiveness) were infrequently discussed. Both patients and clinicians showed predominantly neutral to positive attitudes towards CM.ConclusionsThis study shows that patients are still the main initiators of discussions about CM and the topic is not consistently discussed in daily oncology practice.Practice implicationsIf exploration of patients’ interest in CM or its use became routine in oncology practice, it may relieve patients of the burden of introducing the topic, decrease potential risks of CM use and increase access to evidence-based CM for all patients with cancer.     

Russian–American health care: Bridging the communication gap between physicians and patients

ObjectivesThe objectives of this article are two-fold: (1) to gather in one place reliable information about Russian–Americans’ past medical practices and their current outlook on health care and to provide health care professionals with an overview of the major afflictions suffered by this ethnic group; and (2) to educate Russian-speaking patients about the American heath care system and social services geared towards immigrants by locating and evaluating free, culturally appropriate patient education Web sites available in Russian.MethodsIn order to draw data on specific diseases and conditions affecting the Russian-speaking population, the author searched various scholarly health-related electronic databases. A number of well-established U.S. government consumer-health Web sites were searched to locate patient education resources that can be utilized by recent Russian immigrants.ResultsThe author provides an overview of the major health problems encountered by the Russian-speaking population before emigration and potential health concerns for Russian immigrant communities. In addition, the author provides a scholarly exploration of patient education materials available in Russian.ConclusionIn this increasingly diverse society, physicians are faced with the challenge of providing culturally sensitive health care. Multicultural Web-based health resources can serve as a valuable tool for reducing communication barriers between patients and health care providers, thus improving the delivery of quality health care services. Recommendations for further research are indicated.Practice implicationsThe author offers recommendations for practitioners serving Russian-speaking immigrants. Suggestions on utilization of Web resources are also provided.     

The doctor and the patient--how is a clinical encounter perceived?

Objective

To examine the population distribution of different types of relationships between people with chronic conditions and their doctors that influence decisions being made from a shared-decision making perspective.

Methods

A survey questionnaire based on recurring themes about the doctor/patient relationship identified from qualitative in-depth interviews with people with chronic conditions and doctors was administered to a national population sample (n = 999) of people with chronic conditions.

Results

Three factors explained the doctor/patient relationship. Factor 1 identified a positive partnership characteristic of involvement and shared decision-making; Factor 2 doctor-controlled relationship; Factor 3 relationship with negative dimensions. Cluster analysis identified four population groups. Cluster 1 doctor is in control (9.7% of the population); Cluster 2 ambivalent (27.6%); Cluster 3 positive long-term relationship (58.6%); Cluster 4 unhappy relationship (4.4%). The proportion of 18-34 year olds is significantly higher than expected in Cluster 4. The proportion of 65+ year olds is significantly higher than expected in Cluster 1, and significantly lower than expected in Cluster 4.

Conclusion

This study adds to shared decision-making literature in that it shows in a representative sample of people with chronic illnesses how their perceptions of their experiences of the doctor-patient relationship are distributed across the population.

Practice implications

Consideration needs to be given as to whether it is better to help doctors to alter their styles of interactions to suit the preferences of different patients or if it is feasible to match patients with doctors by style of decision-making and patient preference.     

How should alternative medicine be taught to medical students and physicians?

Advocates of alternative medicine are critical of current medical curricula, and have proposed fundamental changes, including the introduction of "integrative medicine" programs to teach alternative medicine. Medical educators have not replied to these criticisms, and have not developed basic curricula in alternative medicine. The author analyzes the alleged deficiencies in medical education, which are based on misrepresentations of medicine and medical training. (For example, critics state that physicians ignore mind-body interactions; in response, several examples are given to show that training physicians to consider the whole person and to identify and address emotional and social problems-the biopsycho-social model-are central tenets of medical education.) The author also examines fundamental differences between traditional and alternative medicine (e.g., their different attitudes toward the importance of evidence; the vitalistic versus the biomedical models of health and disease) that are central to the issue of how alternative medicine should be taught. He concludes that physicians need additional education in order to provide guidance to patients, but teaching about alternative medicine should be evidence-based, not merely the transmission of unproven practices.     

Training health professionals in patient-centered communication during magnetic resonance imaging to reduce patients’ perceived anxiety

ObjectiveWe examined how a patient-centered communication training program for magnetic resonance imaging (MRI) affected health professional (HP) practice and patients’ perceived anxiety (PA).MethodsWe implemented an intervention program. Six of the 17 eligible HPs completed the study. The proportion of observed desired behaviors (PODBs), including MRI procedure explanation (MRI-PE), communication, and MRI checking procedures was measured using an observation grid. We tested 182 patients (85 pre-, 58 post-, and 39 at follow-up) for PA pre- and post-MRI.ResultsThe Bayesian ANOVA effect size suggested moderate evidence of improvement in HP PODBs, pre- to post-intervention. Use of MRI-PE declined between post-intervention and follow-up (6 months later). Observed changes in PA, pre- to post-MRI, could be related to time constraints and perceived pressure to explain the exam in detail once institutional routines are reestablished.ConclusionIn MRI units, time constraints condition the performance of HPs who address patients’ PA.Practice implications“Real workplace” interventions that promote better patient-centered communication and provide each patient with a comprehensive explanation of MRI procedures also appear to improve HP PODBs.     

How is test-related information communicated in Australian Emergency Departments? – ED clinicians’ and patients’ perspectives

ObjectivesTo investigate the communication processes involving test-related information in Australian Emergency Departments (EDs); specifically what and how ED clinicians communicate test-related information to patients, what patients know and understand about the provided information, and how patients view the potential to access their test-results electronically.MethodsWe conducted face-to-face semi-structured interviews with clinicians (n = 26) and patients (n = 32) across three Australian EDs. Interviews were transcribed and analysed iteratively, following principles of qualitative content analysis and grounded theory.ResultsDepending on various contextual (e.g. time pressures) and patient factors (e.g. perceived health literacy), ED clinicians provided, and patients recalled receiving, test-related information along a continuum, ranging from “no or limited” information to “specific” information. Many patients were confused about how to access their test-results. Patients welcomed the potential for future electronic access to results but viewed their individual health and/or computer literacy skills and knowledge as potential barriers.ConclusionsEDs are highly dynamic environments where contextual forces impinge on the amount and quality of test-related information that clinicians communicate to ED patients.Practice ImplicationsSystemic and patient factors need to be addressed to optimise the provision of test-related information in ED settings, improve patient understanding and foster patient empowerment.     

How patient-centred am I?: A new method to measure physicians’ patient-centredness

OBJECTIVE: To describe a new method to determine physicians' self-perceived degree of patient-centredness. A pilot study combining qualitative and quantitative methods. METHODS: Forty-one general practitioners (GPs) answered a questionnaire consisting of three open-ended questions about their view of the consultation and by choosing among 28 roles of the physician in the physician-patient relationship. Twenty of the GPs had participated in Balint groups while 21 had had no access to Balint group. Patient-centredness is central to Balint groups and consequently Balint group participants would be expected to be patient-centred. RESULTS: The answers to the two parts were divided into three groups each, patient-centred, non-patient-centred and intermediary, and analysed statistically. Significantly more Balint participants were patient-centred than the reference group. CONCLUSION: The instrument describes physicians' self-perceptions of their patient-centredness and can distinguish a group of patient-centred physicians from a group of non-patient-centred physicians. PRACTICE IMPLICATIONS: The instrument can be useful to evaluate educational programmes and detect decline in patient-centredness as early sign of burnout.