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.     

Gender,Affiliation, and Control in Physician–Patient Encounters

This study investigates the effects of physician gender and communication styles on participant responses to physicians. Participants were 146 mostly low-income students (50% Caucasian, 50% African-American) who each viewed one of four videotapes of physicians varying in communication style (affiliative, controlling) and gender (male, female). The affiliative communication style evoked the greatest levels of participant satisfaction, trust, self-disclosure, and compliance. Physician gender did not significantly affect these variables. Participants' recall of medical information showed an interaction: When the physician was male, participants recalled more when he was controlling than when he was affiliative; when the physician was female, communication style did not affect participant recall. Results suggest that physician communication style is more important than gender in determining patient response.     

Physician and patient communication training in primary care: effects on participation and satisfaction

OBJECTIVE: To assess the effects of a communication skills training program for physicians and patients. DESIGN: A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). MAIN OUTCOME MEASURES: Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians' satisfaction and stress; and global ratings of the communication process. RESULTS: The following significant (p < .05) effects emerged: physician training improved patients' satisfaction with information and overall care; increased willingness to recommend the physician; increased physicians' counseling (as reported by patients) about weight loss, exercise, and quitting smoking and alcohol; increased physician satisfaction with physical exam detail; increased independent ratings of physicians' sensitive, connected communication with their patients, and decreased physician satisfaction with interpersonal aspects of professional life. Patient training improved physicians' satisfaction with data collection; if only physician or patient was trained, physician stress increased and physician satisfaction decreased. CONCLUSION: Implications for improving physician-patient relationship outcomes through communication skills training are discussed.     

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.     

Cognitive and emotional control and perspective taking and their relations to empathy in 5-year-old children

The experience of empathy has been described as involving both emotional and cognitive components. The primary hypothesis tested in this study is that cognition and emotion are integrated within 2 distinct types of abilities-control and perspective taking-and that interactions between emotional and cognitive control and between affective and cognitive perspective taking would be related to children's empathic responding. We also hypothesized that boys' control and perspective-taking skills would be more strongly related to empathy than would those of girls. Fifty-seven 5-year-olds completed tasks measuring cognitive control, cognitive and affective perspective taking, and empathy, and their mothers completed a measure of children's emotional control. Results indicated that cognitive perspective taking moderated the relation between affective perspective taking and empathy. In addition, the relation between cognitive inhibitory control and empathy was moderated by gender; boys' control was positively related to empathy, but girls' control was marginally negatively related to empathy.     

团体咨询成员的相互共情及其与效果的关系——社会关系模型在团体咨询研究中的应用

研究旨在探讨团体成员的相互共情及其与团体效果的关系。共收集10个团体,53名成员的数据,运用社会关系模型分析。结果发现：1.成员自评相互共情得分较高,但互评相关不显著;2.共情水平与会谈效果正相关,与团体反治疗性因素负相关;3.被共情水平与不信任负相关;4.共情准确性与团体治疗性因素正相关。结论：成员自评相互共情水平较高,但互评不匹配。成员自评共情水平越高,会谈效果越好,受团体反治疗性因素阻碍更少。越被准确评估情绪效价的成员,从治疗性因素中获益更多。     

Self and Other Ratings of Dyadic Empathy as Predictors of Relationship Satisfaction

In this study, self and other ratings of dyadic empathy are proposed to predict relationship satisfaction. One-hundred and fifty-one individuals over the age of eighteen who were in a relationship of at least six months in length at the time of the survey completed the Interpersonal Reactivity Index for Couples (Péloquin & Lafontaine, 2010) and the Couples Satisfaction Index (Funk & Rogge, 2007). Total scores for self and other rated dyadic empathy as well as scores of the congruity between self and other were assessed for each respondent. The results indicated that total perceived dyadic empathy and perceived dyadic empathic congruity were significant predictors of relationship satisfaction.     

Beyond Credentials: The Effect of Physician Sex and Specialty on How Physicians Are Perceived

The experiment investigated the effect of physician sex and specialty on participants’ perceptions of doctors. Participants (N = 206) viewed a physician profile (male/female orthopedic surgeon or male/female dermatologist) and then evaluated the physician on a survey. While male participants reported they would be more willing to see a female physician and believed female physicians would be more caring, female participants reported they would be more willing to see physicians in counter-stereotypical specialties and rated them as more caring. The study suggests that not only do men and women focus on different things in selecting physicians but also that negative stereotypes of female physicians have dramatically decreased.     

团体成员共情的影响因素及作用模型——基于扎根理论

本研究旨在探索团体咨询成员共情的概念、影响因素及其作用。运用扎根理论对11名团体咨询成员的访谈资料分析,共形成11个轴心编码。根据编码间的关系得到如下结果：1. 团体成员共情包括共情理解、共情表达和共情感知;2. 团体成员共情理解的影响因素为相似性、观点采择;共情感知的影响因素为相似性和共情表达;3. 团体成员共情通过促进成员关系、认知领悟和情感支持提升团体效果。据此构建了团体成员共情的影响因素及作用模型。     

Relationships among perceived psychological growth,resilience and burnout in physicians

The purpose of this study was to examine the relationships between perceived growth as a physician (i.e., positive psychological changes experienced as a result of the professional experience) and burnout after controlling for the effects of perceived family support, dispositional resilience, age, and marital status among physicians. Physicians (n = 289) rated perceived support from family and completed the short form of the Posttraumatic Growth Inventory, the Resilience Scale, and Maslach Burnout Inventory. Results of hierarchical regression analyses revealed that the addition of perceived growth significantly improved prediction of resilience and perceived family support for burnout, showing that higher growth, resilience, and family support all were associated with lower levels of burnout. Moreover, the effects of growth on depersonalization, a domain of burnout, were stronger for physicians who perceived a lower level of family support, whereas the effects of growth on personal accomplishment, another domain of burnout, were stronger for physicians who showed a lower level of dispositional resilience. Current results have clinical implications for understanding protective factors for burnout, that is, a sense of personal growth may be a key factor for physicians who may be less resilient or may not perceive strong family support.     

The Developmental Trajectory of Empathy and Its Association with Early Symptoms of Psychopathology in Children with and without Hearing Loss

Empathy enables people to share, understand, and show concern for others’ emotions. However, this capacity may be more difficult to acquire for children with hearing loss, due to limited social access, and the effect of hearing on empathic maturation has been unexplored. This four-wave longitudinal study investigated the development of empathy in children with and without hearing loss, and how this development is associated with early symptoms of psychopathology. Seventy-one children with hearing loss and cochlear implants (CI), and 272 typically-hearing (TH) children, participated (aged 1–5 years at Time 1). Parents rated their children’s empathic skills (affective empathy, attention to others’ emotions, prosocial actions, and emotion acknowledgment) and psychopathological symptoms (internalizing and externalizing behaviors). Children with CI and TH children were rated similarly on most of the empathic skills. Yet, fewer prosocial actions were reported in children with CI than in TH children. In both groups, affective empathy decreased with age, while prosocial actions and emotion acknowledgment increased with age and stabilized when children entered primary schools. Attention to emotions increased with age in children with CI, yet remained stable in TH children. Moreover, higher levels of affective empathy, lower levels of emotion acknowledgment, and a larger increase in attention to emotions over time were associated with more psychopathological symptoms in both groups. These findings highlight the importance of social access from which children with CI can learn to process others’ emotions more adaptively. Notably, interventions for psychopathology that tackle empathic responses may be beneficial for both groups, alike.

     

Primary care physicians attitude toward diagnosis and treatment of late-life depression

Underdiagnosis and undertreatment of late-life depression is common, especially in primary care settings. To help assess whether physicians attitude and confidence in diagnosing and managing depression serve as barriers to care, a total of 176 physicians employed in 18 primary care groups were administered surveys to assess attitudes towards diagnosis, treatment, and management of depression in elderly patients, (individuals over 65 years of age). Logistic regression was performed to assess the association of physician characteristics on attitudes. Nearly all of the physicians surveyed felt that depression in the elderly was a primary care problem, and 41% reported late-life depression as the most common problem seen in older patients. Physicians were confident in their ability to diagnose and manage depression, yet 45% had no medical education on depression in the previous three years. Physicians confidence in their ability to diagnose, treat, and manage depression, and their reported adequacy of training, do not appear to correspond to the amount of continuing medical education in depression, suggesting that physician overconfidence may potentially be serving as a barrier to care.     

The value of emotionally expressive visual art in medical education

This paper approaches the topic of visual art in medical education from a philosophical perspective, drawing on arguments from epistemology, philosophy of science, aesthetics, and contemporary ethical theory. Several medical ethicists have noted that the traditional clinical paradigm may increase the epistemic and emotional distance between patient and physician in part by focusing on the physical body and medical technology. Some of these same writers recommend a new approach to patients based on empathy and increased attention to suffering. After reviewing these arguments, supporting examples, and recommendations, I explain how visual art that expresses or symbolizes the emotional response to illness could be used to introduce an additional paradigm into medical education. This would be a paradigm based on empathetic attention to patients' emotional experiences in illness. My own argument is that this additional way of perceiving and relating to patients may reduce the distance between patient and physician and may allow physicians to better meet the ideal of treating the patient as a person.     

Not Only the Miserable Receive Help: Empathy Promotes Prosocial Behaviour Toward the Happy

Two studies investigated how person- and situation-related information elicit empathy and subsequent prosocial behaviour. Results show that congruent information (for example, positive emotion after positive event) elicits more empathy than incongruent information (for example, negative emotion after positive event). The extent of prosocial behaviour was observed to be an additive effect of person- and situation-related information, with congruent negative information eliciting most prosocial behaviour (study 1). In addition to an observed direct effect of perceived negative affect, empathy partially mediated prosocial behaviour in response to perceived positive affect. Corroborating these results, study 2 indicates a full mediation effect of empathic responsiveness to happiness on prosocial responding. This suggests that two different mechanisms may trigger prosocial behaviour: a direct influence of perceived negative affect, and an empathy mediated influence of perceived positive affect.     

Peer support for women with breast cancer: the role of empathy and self‐disclosure

This study examined how women with breast cancer perceived different styles of peer helping. Forty recently diagnosed breast cancer patients evaluated three audiotaped conversations between a breast cancer patient and an (ex‐patient) volunteer helper; the conversations differed in terms of the empathy and self‐disclosure offered by the helper. The findings supported the first hypothesis, that a helping style involving high self‐disclosure would be positively evaluated only in the presence of high empathy. However, the findings did not support the second hypothesis, that in conversations where high empathy is present, a helping style involving high self‐disclosure would be evaluated more positively than one involving low self‐disclosure. Qualitative data suggested that the helper's ability to listen to the patient and the helper's appropriate sharing of her own experience of breast cancer were both perceived as important components of effective helping. Implications for the training and practice of volunteer helpers are discussed. Copyright © 1999 John Wiley & Sons, Ltd.     

Self-functioning and perceived parenting: relations of parental empathy and love inconsistency with narcissism, depression, and self-esteem

In Heinz Kohut's (1977, 1984) theory of the psychology of the self, good parenting provides a child with optimal frustration and just the right amount of loving empathic concern. In the present study, the authors examined the relations of perceived parental empathy and love inconsistency with measures of narcissism, self-esteem, and depression. In a sample of university undergraduates (N=232; 78 men, 153 women, and 1 nonresponder), perceived parental empathy predicted more adaptive self-functioning, whereas parental love inconsistency was related to psychological maladjustment. These results support the theoretical assumption that perceived parental empathy is associated with healthy self-development.     

Empathic understanding: Benefits of perspective-taking and facial mimicry instructions are mediated by self-other overlap

The current study sought to better understand the utility of two strategies—perspective-taking and facial mimicry—proposed to increase empathic responding. Thirty-seven female participants were presented an interpersonal situation (a betrayal) that would elicit the use of empathic responding to achieve conflict resolution between friends. Each participant was given instructions to partake in either perspective-taking, facial mimicry, or to remain neutral (control condition). The results demonstrated that individuals who engaged in perspective-taking reported significantly higher state empathy than the control condition, but there was no significant difference in state empathy between the mimicry and control condition. Also, those who engaged in either strategy reported significantly higher self-other overlap relative to those not instructed to engage in a particular strategy. Importantly, self-other overlap mediated the association between the instructional sets and state empathy. Both strategies are arguably means of enhancing interpersonal understanding.     

Professional Autonomy in Belgium

The Belgian health care system has a few features that may havecontributed to the rising costs of health care: patients' freechoice of physicians, large clinical freedom of physicians, essentiallya fee-for-service remuneration for medical specialists in which the feesare agreed between insurance funds and physicians. The increased medicalconsumption and costs have prompted the state and insurance companies totake measures that limit the professional autonomy of the physicians.Access to medical education, free until 1997, is now restricted. Themedical profession is organized in the Order of Physicians that hasestablished a code of professional ethics that has moral but not legalforce. So far, there is no special legislation for thepatient–physician relationship, though laws on specific issueslike organ transplantation contain duties for physicians. In recentyears a debate is taking place on patients' rights, of which informedconsent is central and gaining importance in medico-legal publications.An analysis of (ethical and legal) regulations concerning thewithholding or withdrawal of treatment by physicians demonstrate thatthe profession still enjoys a large clinical autonomy, though duediscussion with the patient has become more explicitly required. Therespect for professional autonomy is not primarily due to any formalpower that the Order of Physicians would have, but is rather grounded inthe generally high quality of the patient–physician relationshipthat in ethical terms is considered essentially as a confidencerelationship rather than a contractual relationship.     

医学生疼痛共情的认知过程特征：来自ERP的证据

以往研究发现临床医生的疼痛共情显著低于常人,表现为前者感知他人疼痛时会出现早期情绪分享和晚期情绪调节的相对抑制。而处于职前培养期的医学生是否存在相似问题,其疼痛共情又是否会受到重复暴露的影响,目前并不清楚。为此,本研究采用ERP技术比较了医学与非医学专业大学生疼痛共情的认知过程,并通过前后测设计检验了重复暴露对二者疼痛共情的影响。行为结果发现两组被试的主观疼痛判断都出现了疼痛共情效应,但未出现组别差异,也未发现重复暴露的影响。但ERP结果显示,医学生的疼痛共情过程显著区别于非医学生。他们虽表现出早期情绪分享成分N1的抑制效应,但LPP反映的晚期认知加工却显著增强,且上述两阶段加工均未受到重复暴露的显著影响。研究表明：（1）医学学习能够抑制疼痛共情的早期情绪分享,但医学生仍可通过更多晚期认知资源投入来维持其疼痛共情水平。（2）医学生的疼痛共情较少受到重复暴露的影响,呈现情绪适应特点。     

Physician Beliefs about Physical and Mental Competency of Patients Applying for Concealed Weapon Permits

Law enforcement officials have asked health care providers to evaluate patient applications for concealed weapon permits. The current study was designed to examine physician beliefs regarding competency to carry a concealed weapon for patients with specific physical and mental conditions. Among 222 North Carolina physicians who participated in this survey (40% response rate), large variation and uncertainty existed for determining competency. Physicians most frequently chose mild dementia, post-traumatic stress disorder, and recent depression as conditions that would render a patient not competent to carry a concealed weapon. Male physicians and those owning a gun were more likely to deem a patient competent. Almost a third of physicians were unsure about competence for most conditions. Physicians asked to assess competency of patients to carry a concealed weapon have quite disparate views on competency and little confidence in their decisions. If physicians are expected to assess patient competence to carry a concealed weapon, more objective criteria and training are needed. Copyright © 2015 John Wiley & Sons, Ltd.