Relationship of physicians' nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload

A field study of 28 residents in family practice was conducted. Physicians' self-reports of empathy, self-monitoring ability, and affective communication skill as well as their objectively measured nonverbal communication skills were examined as predictors of patient satisfaction, appointment noncompliance, and physician workload (schedule density). Physicians completed the Hogan Empathy Scale, Snyder Self-Monitoring Scale, Affective Communication Test, short form of the Profile of Nonverbal Sensitivity, and a nonverbal encoding task. Patient satisfaction with communication, affective care, and technical care was assessed using a 25-item, visit-specific satisfaction scale. Appointment records were used to determine the number of patients seen by each physician and the compliance of patients with scheduled appointments. Results indicated that the three self-report measures were unrelated to the measures of patient noncompliance and patient satisfaction, but self-reported affective communication ability was significantly correlated with physician workload. Objectively measured physician sensitivity to audio communication predicted patient compliance: More sensitive physicians experienced fewer unrescheduled appointment cancellations. Nonverbal encoding skill was significantly related to patient satisfaction with affective care and to physician workload.     

Communication Differences Between Physicians and Their Patients in an Oncology Setting

The physician-patient relationship has critical importance in the quality of medical care, especially in the oncology setting. Of particular interest over the past two decades has been the communication between physicians and their patients. It is understood that communication is related to patient and physician satisfaction as well as other medical outcomes. However, despite this interest and attention, investigators have only recently begun to assess the communication between physicians and patients from the patient's point of view. Additionally, previous investigations have primarily relied upon retrospective reports of the interaction from patients or physicians. The current investigation assessed physician–patient communication in an oncology setting, both as it was occurring and following the interaction. The units of analysis included participant ratings as well as those of trained observers. Findings revealed that physicians and patients disagree as to the valence of the messages which transpired. Additionally, results suggest that it is the patients who distort the messages in the positive direction. Research and clinical implications of this disagreement and positivity bias are discussed.     

Doctor Communication Style and Patient Outcomes: Gender and Age as Moderators

Past research has demonstrated that physicians' communication styles influence patient satisfaction, loyalty, recall of medical advice, and adherence to this advice. However, the research has failed to identify coherent interactional styles that produce favorable outcomes along all dimensions. The present study used a videotape analogue method to compare the efficacy of two communication styles that vary in terms of the power relations between the parties. Community members adopted the role of the patient and rated a male or female "doctor" using either an authoritative or a consultative communication style. Results indicate that the consultative style yielded superior satisfaction ratings, but not greater recall or adherence. The effects for style were moderated by significant interactions with physician gender and patient age.     

Physician Burnout and Patient Satisfaction with Consultation in Primary Health Care Settings: Evidence of Relationships from a one-with-many Design

Physician burnout, as a prolonged response to chronic emotional and interpersonal stressors on the job, has been associated with suboptimal patient care and deterioration in the patient?Cprovider relationship. Although prior studies have identified a range of factors associated with decreased patient satisfaction, most have been conducted in tertiary care settings, with staff burnout examined at the hospital unit-level. To examine the impact of physician burnout on patient satisfaction from consultation in the primary care setting, a cross-sectional survey was conducted in Western Greece. Using a one-with-many design, 30 physicians and 300 of their patients, randomly selected, responded to the survey. Results showed that patient satisfaction correlated significantly with physician emotional exhaustion (r = ?.636, p < .01) and physician depersonalization (r = ?.541, p < .01). Mixed-effects multilevel models indicated that 34.4% of total variation in patients?? satisfaction occurred at the physician level, after adjustment for patients?? characteristics. Moreover, physician emotional exhaustion and depersonalization remained significant factors associated with patient satisfaction with consultation, after controlling for patient and physician characteristics. Patients of physicians with high-exhaustion and high-depersonalization had significantly lower satisfaction scores, compared with patients of physicians with low-exhaustion and low-depersonalization, respectively. Future studies need to explore the mechanisms by which physician burnout affects patient satisfaction.     

A study of the relationship between individual differences in nonverbal expressiveness and factors of personality and social interaction

Some theoretical and applied implications of individual differences in nonverbal expressiveness were investigated in a medical setting. In Study I, the abilities of 21 physicians to express different emotions through voice tone were assessed and related to physician personality and to actual patient ratings of the physician. Study II replicated Study I using visual as well as vocal cues (i.e., videotapes) of a new sample of physicians, and added a study of physician greetings. It was found that: (1) Aspects of expressive ability were reliably correlated with a cluster of personality traits, thus supporting the notion that nonverbal affective style may be a window to inner dispositions; and (2) expressive ability was related to patient satisfaction with the interpersonal manner of their physicians and to the judged likeability of the physician's greeting, thus providing evidence for the importance of this ability for social interaction.     

Compliance and Satisfaction With Physician-Patient Communication An Expectancy Theory Interpretation of Gender Differences

This pair of studies sought to apply the explanatory calculus of expectancy theory to examine patient compliance and satisfaction with physicians’ instructions. Study 1 analyzed the differential expectations of patients based on gender of the physician. Results indicated that female physicians are expected to use instrumentally unaggressive strategies while male physicians are expected to use strategies that fall in the mid-range of a verbal aggression continuum. There were no differences in expectations based on the gender of patients. The second study manipulated physician communication and physician gender to predict an interaction such that when male physicians deviate from moderately aggressive, direction-giving strategies, using either more affiliative tactics or more instrumentally aggressive strategies, compliance increases. It was also predicted that affective satisfaction with male physicians would increase with increased use of affiliative, nonaggressive compliance-gaining messages. Based on expectancy theory, an inverse linear relationship between the use of instrumental verbal aggression and compliance and affective satisfaction was predicted for female physicians. Results supported the posited interaction. Implications for further refinement of expectancy theory are discussed, and practical implications for physician-patient communication in clinical situations are offered.     

"Trust me...": psychological and behavioral predictors of perceived physician empathy

A sociocognitive model of distal and proximal predictors of empathic judgments was tested among 100 physicians. The authors hypothesized that physician perceived control would affect empathy ratings via physician communication style. Specifically, physicians with high perceived control would use more open communication and be rated as more empathic. Physicians with low perceived control would use a controlling communication style and be rated as less empathic. Physicians completed a medical attribution questionnaire prior to a structured patient consultation exercise, during which patients and assessors rated physician empathy. The exercise was audiotaped, transcribed, and content analyzed for verbal behaviors. Support was found for the hypotheses; however, patients, but not medical assessors, associated empathy with reassurance and provision of medical information.     

A Model of Professional Development for Practicing Genetic Counselors: Adaptation of Communication Skills Training in Oncology

Ongoing professional development for practicing genetic counselors is critical in maintaining best practice. Communication skills training (CST) workshops for doctors in oncology, utilizing trained actors in role plays, have been implemented for many years to improve patient-centred communication. This model was adapted to provide professional development in counseling skills for practicing genetic counselors, already highly trained in counseling skills. Detailed evidence based scenarios were developed. Evaluation of participants’ experience and perceived outcomes on practice included surveys immediately post workshops (2002, 2004, 2005, 2008 (×2); n = 88/97), 2–5 years later (2007; n = 21/38) and a focus group (2007; n = 7). All rated workshops as effective training. Aspects highly valued included facilitator feedback, actors rather than role-playing with peers and being able to stop and try doing things differently. Perceived outcomes included the opportunity to reflect on practice; bring focus to communication; motivation and confidence. The high level of satisfaction is a strong endorsement for ongoing communication skills training in this format as part of professional development.     

The Patient–Doctor Relationship Questionnaire (PDRQ-9) in Primary Care: A Validity Study

This study assessed the validity of the Patient–Doctor Relationship Questionnaire-9 (PDRQ-9) in a primary care sample (N = 180). Convergent validity was assessed through a correlation between the patient-rated PDRQ-9 and the physician-rated Difficult Doctor Patient Relationship Questionnaire-10 (DDPRQ-10). Discriminant validity was assessed through correlations between the PDRQ-9 and patient age, patient- and physician-reported health and psychological distress. To determine if the PDRQ-9 could discriminate between groups, patient PDRQ-9 ratings were compared between patients who were treated by faculty physicians versus those who were treated by residents. An exploratory factor analysis confirmed that the PDRQ-9 was made up of a single factor. The PDRQ-9 scale was internally consistent (α = .96) and significantly and negatively correlated with the DDPRQ-10 (r = ?.22, p = .003) and was not significantly correlated with patient age, health, or psychological distress. PDRQ-9 ratings were statistically greater in patients who were treated by faculty physicians than those who were treated by residents (p = .01). This study provides additional support for the reliability and validity of the PDRQ-9 as a measure of the doctor–patient relationship in a primary care sample.     

Guidelines for Writing Letters to Patients

Patient letters provide a permanent record of the genetic counseling that was provided and are unique in medical care; rarely do other health care providers send summaries written specifically to their patients and families. We surveyed genetic counseling training program directors and found that while the acquisition of patient letter-writing skills was considered important, there were no specific guidelines made available to students. To develop letter-writing guidelines, we evaluated patient letters, reviewed references on professional correspondence, surveyed the medical literature, and worked with a writing consultant. The guidelines we subsequently developed and present here include a format for writing patient letters, suggestions on presenting medical information in understandable terms, and wording considerations. These patient letter-writing guidelines are intended to serve as a guide for teaching students this important skill and as a resource for practicing health care professionals.     

How Does Your Doctor Talk with You? Preliminary Validation of a Brief Patient Self-Report Questionnaire on the Quality of Physician–Patient Interaction

The quality of physician–patient interaction is increasingly being recognized as an essential component of effective treatment. The present article reports on the development and validation of a brief patient self-report questionnaire (QQPPI) that assesses the quality of physician–patient interactions. Data were gathered from 147 patients and 19 physicians immediately after consultations in a tertiary care outpatient setting. The QQPPI displayed good psychometric properties, with high internal consistency and good item characteristics. The QQPPI total score showed variability between different physicians and was independent of patients’ gender, age, and education. The QQPPI featured high correlations with other quality-related measures and was not influenced by social desirability, or patients’ clinical characteristics. The QQPPI is a brief patient self-report questionnaire that allows assessment of the quality of physician–patient interactions during routine ambulatory care. It can also be used to evaluate physician communication training programs or for educational purposes.     

Associations Between Participant Ratings of PREP for Strong Bonds and Marital Outcomes 1 Year Postintervention

After completing a relationship education program, collecting participant evaluations of the program is common practice. These are generally used as an index of “consumer satisfaction” with the program, with implications for feasibility and quality. Rarely have these ratings been used as predictors of changes in marital quality, although such feedback may be the only data providers collect or have immediate access to when considering the success of their efforts. To better understand the utility of such ratings to predict outcomes, we evaluated links between participant ratings and changes in self-reported marital satisfaction and communication scores 1 year later for a sample of 191 Army couples who had participated in a relationship education program delivered by Army chaplains (PREP for Strong Bonds). Overall ratings of general satisfaction with the program and the leader did not predict changes in marital outcomes 1 year later, whereas higher ratings of how much was learned, program helpfulness, increased similarity in outlook regarding Army life, and helpfulness of communication skills training predicted greater change in communication skills 1 year later. Higher ratings of items reflecting intent to invest more time in the relationship, and increased confidence in constructive communication and working as a team with the spouse predicted greater increases in both marital satisfaction and communication skills 1 year later. The constructs of intention and confidence (akin to perceived behavioral control) suggest that the Theory of Planned Behavior may be particularly useful when considering which Army couples will show ongoing benefit after relationship education.     

Satisfaction with care among low-income female outpatients

Patient satisfaction correlates with important health behaviors and outcomes. Little is known about satisfaction in disadvantaged populations of different racial/ethnic backgrounds. The current study evaluated demographic and psychological correlates of patient satisfaction among a low-income, multiethnic sample of female outpatients attending cervical cancer screening. Participants included 338 African American, Latina, and white women ages 18 - 49 years attending University of Texas Medical Branch Regional Maternal & Child Health Clinics. Data were obtained via self-report and chart review. Patient satisfaction was assessed using the Patient Satisfaction Questionnaire (PSQ). Total PSQ scores reflected two distinct underlying subscales (satisfaction and dissatisfaction), which differed from the original factor structure of the PSQ. Satisfaction was predicted by patient beliefs that their health is self-determined, beliefs that doctors control their health, self-esteem, and education. Dissatisfaction was predicted by patient beliefs that good health is a matter of chance/luck, self-esteem, social desirability, and income. Higher self-esteem, education, and beliefs that health is controlled by oneself or doctors correlated with higher satisfaction with care in the clinic setting. Understanding the influence of patient characteristics on perceptions of care is important for physicians to foster relationships with patients that increase feelings of satisfaction, decrease dissatisfaction, and ultimately, improve health outcomes.     

Selecting nonprofessional counselor trainees with the Group Assessment of Interpersonal Traits (GAIT)

The GAIT is a procedure for sampling and measuring communication behavior. Candidates for a counselor-training program (136 Ss; 86% women; average age 44 yr.) took the GAIT in 18 groups and completed written forms for staff screening. Data included pre-GAIT first impression peer ratings and GAIT Empathy. Acceptance, and Openness ratings by peers and by trained audiotape judges. After nine months of training, 26 remaining Ss were judged on a counseling readiness criterion. First impression and peer GAIT ratings were positively intercorrelated, but none predicted counseling readiness. The criterion was correlated with both trained GAIT Empathy (Kendall tau = .40) and staff ratings (.41. both ps less than .01). Suggestions were made for using the GAIT as a counselor selection instrument.     

Ethical Issues in Family-Centered Primary Care

In 1969 a new primary care medical specialty, family practice, was formally created. One element in the development of this specialty from the roots of general practice was an understanding of the importance of family process in health and health care. Family physicians are now trained to work with families in the provision of primary medical care, and many provide some formal family counseling and therapy. The family physician who works with families faces many of the same ethical conflicts with which family therapists are confronted. The primary relationship of the family physician to his or her patients, however, as the provider of continuing health care, modifies these conflicts and creates new and vexing problems.     

Compassionate stereotyping of elderly patients by physicians: revising the social contact hypothesis

Departing from previous research on age stereotypes, this study examined degree of contact with elderly patients as a factor affecting age stereotyping by physicians. Included are measures of behavioral intentions as well as more traditional attitudinal measures. A total of 63 rheumatologists completed a brief questionnaire on which they rated a 53- or an 83-year-old target patient on a number of dimensions including psychological adjustment and need for support and information. Patients' age and physicians' degree of contact with elderly patients had few direct effects on physicians' ratings; their interaction, however, yielded a strong and consistent finding: The elderly patient was rated as less adjusted, autonomous, and instrumental and in greater need of support and information by high-contact physicians. These findings suggest that although negative age stereotypes are less prevalent than has previously been indicated, rheumatologists, particularly those who treat elderly patients, may draw on compassionate stereotypes in their care of elderly patients.     

COMMUNICATION SKILLS TRAINING FOR PARENTS: EXPERIMENTAL AND SOCIAL VALIDATION

Coordination of professional services on behalf of children often hinges on the involvement of informed parents. The purposes of this study were to identify and experimentally and socially validate skills required of parents for effective communication with professionals. Target skills were identified on the basis of judges' social validation ratings of (a) sample interactions between parents and professionals and (b) the behaviors comprising a resultant task analysis. Eight parents were then trained in these skills via an instructional package. Results of a multiple baseline design across subjects and grouped skill domains showed that each parent acquired the targeted skills during simulated conferences and that correct responding usually generalized to actual conferences. Independent judges validated training outcomes, and participating parents indicated satisfaction with the curriculum.     

What is competent communication behaviour of patients in physician consultations? – Chronically-ill patients answer in focus groups

Many desirable outcomes depend on good patient-physician communication. Patient-based perspectives of what constitutes competent communication behavior with physicians are needed for patient-oriented health care. Therefore it was our main aim to identify competent patient communication skills from the patient’s perspective. We also wanted to reveal any differences in opinion among various groups (chronic ischemic heart disease, chronic low back pain, breast cancer). This study examined nine guideline-supported focus groups in rehabilitation centers. The criterion for study inclusion was any one of the three diagnoses. Enrolled in the study were N = 49 patients (32 women) aged M = 60.1 (SD = 12.8). The interview recordings were transcribed and subjected to content analysis. We documented 396 commentaries in these interviews that were allocated to 82 different codes; these in turn resulted in the formation of 12 main topics. Examples are: posing questions, being an active and participatory patient, being aware of emotions and communicating them. This study represents stage two (‘documentation of patient and clinician views’) in the seven-stage model of communication research. Findings reveal that chronically-ill patients name behaviours that contribute to successful discussion with a physician. These enable us to develop communication trainings and design-measuring tools used for patient-based communication skills.     

Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.     

Breast Cancer Risk Assessment at the Time of Screening Mammography: Perceptions and Clinical Management Outcomes for Women at High Risk

The purpose of this study was to evaluate the utility of a breast cancer risk assessment (BCRA) at the time of screening mammogram. Women whose BCRA indicated a high risk for cancer received a letter with instructions for breast health care and genetic counseling if appropriate. After 6 months this group received surveys to evaluate their risk perception and their recall of, and compliance with, recommendations. We also explored the impact of other variables such as a recommendation for genetic counseling and physician communication with the women. After the BCRA, the majority of high risk women reported no change in their perceived risk of cancer. A woman’s perceived risk of cancer after a BCRA was significantly associated with her recall of recommendations for breast health care, but not with compliance. A recommendation for genetic counseling was not significantly related to women’s perceived risk of cancer after the BCRA. Ten percent of women who should have obtained genetic counseling actually completed an appointment. Women who discussed their BCRA results with their physicians were more compliant with a six month breast exam with a doctor (53% vs 17%, p = 0.018). Overall, women felt that the BCRA was helpful and did not cause undue stress or anxiety. Although the cohort’s compliance with recommendations was suboptimal, physicians’ interactions with their patients may have a positive influence on their compliance.