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.     

Ten Years of Career Development: A Nationwide Study of High School Students

The authors summarize trends for several indicators of student career development collected in 1973 (when career education and career planning programs began to receive renewed emphasis) and again in 1983. The indicators, obtained for nationally representative samples of junior and senior high school students (N = 18,129 in 1973 and 15,432 in 1983), included career-related concerns, career planning involvement, and reactions to career planning services. Among the major trends was a 32% increase in the proportion of 11th graders who reported receiving “some” or “a lot” of career planning help from their schools. Moreover, the proportion of students involved in typical career exploration activities increased significantly over the 10 years of the study. In general, the 10-year trends indicate that schools are having a greater impact on student career development than they were in 1973.     

Counseling Clients with AIDS

The authors discuss issues and suggestions relative to counseling clients with AIDS. Several psychosocial issues are presented, and a psycho-educational model of treatment to meet the needs of AIDS clients is described.     

Training Counselors for Work with Special Populations: A Second Look

Literature on the counseling needs of special populations typically has focused on the inadequate treatment those populations receive. Counselor education programs have responded by developing courses that target specific populations such as women, minorities, or disabled people. There are serious drawbacks, however, to this proliferation of specialized courses. In this article the authors discuss those drawbacks and argue that counselor education programs should include an integrated course that facilitates student self-awareness in conjunction with practical experience with a variety of clients.     

The challenge of technology transfer: Buying in without selling out

Highly effective technologies flowing from the discipline of behavior analysis have not been widely adopted, thus threatening the survival of the discipline itself. An analysis of the contingencies underlying successful technology transfer suggests the need for direct, empirical involvement in the marketplace in order to insure that the maximum demonstrable benefits reach the ultimate users. A successful example of this strategy of technology transfer is provided. Three areas of intense national concern-urban violence, illiteracy, and declining industrial productivity-provide immediate opportunities for the technologies of behavior analysis to secure the place of the discipline in the intellectual mosaic of the 21st century.     

Spontaneous alternation behavior in animals: A review

Factors affecting spontaneous alternation behavior (SAB) in animals, for example, age, gender and species studied; type of apparatus and cues employed; and neuro-anatomical, neuro-chemical and motivational status of the organism, were reviewed. Despite a myriad of experiments showing interesting main effects of such variables, little research has been performed assessing the interactive affects of these factors on alternation behavior. For example, psychologists test rats in central nervous system (CNS) lesion studies, whereas psychopharmacologists tend to assess SAB in mice. Most importantly, studies have not been reported investigating the possible interactions among species, brain lesions and drugs. This is an unfortunate omission since several important alternation models include propositions relating to cholinergic and/or serotonergic coding in the hippocampus. Examination of behavioral studies revealed the primary cue for alternation among invertebrates to be body turn, whereas vertebrates rely primarily on directional and odor cues. Reference to the seeking of stimulus change remains the most compelling motivational account of why animals manifest this ubiquitious and reliable behavior pattern. This review and the unpublished studies were supported by Research Grants MH16962, MH21288, and MH36491 from the National Institute of Mental Health and the Wake Forest University Research and Publication Fund.     

Multimodal therapy in an inpatient setting

Inpatient Multimodal Therapy (imt) is a residential treatment program, lasting a maximum of 36 weeks, for patients with severe neurotic symptoms. A group of 44 chronic obsessive-compulsive patients and a group of 40 chronic phobic patients were treated in order to assess the outcome and the process of treatment and to identify prognostic factors associated with the effect. At follow-up—on average, eight months after discharge—it was found that 60% had improved, 32% had remained the same, and 8% had deteriorated, indicating that, in general, the treatment was beneficial. That these effects were long-lasting is supported by the fact that, at follow-up, 78% of all patients were no longer receiving treatment, 18% were receiving outpatient or day treatment, and 4% were receiving inpatient treatment. Phobic patients appear to have gained more from the multimodal approach than did obsessive-compulsive patients, as indicated by the fact that the severity of symptoms decreased as they improved in rational thinking, assertiveness, and arousal. By contrast, obsessive-compulsive patients relapsed more than phobic patients did. This was attributed to the fact that the former gained less from the rational-emotive training, denied problems with assertiveness, and did not practice the acquired relaxation skills. It further appeared that a favorable outcome could be induced in patients who (1) expressed relatively mild symptoms in this otherwise severe group, (2) reported relatively few additional complaints, (3) could clearly indicate interpersonal problems, and (4) did not use psychotropic drugs. These prognostic factors are so widespread that not much weight can be ascribed to them. Yet they are useful for indication ofimt until better predictors are found.