Physician Communication Style Research Articles

Ratings of Physician Communication by Real and Standardized Patients

Patient ratings of physician's patient-centered communication are used by various specialty credentialing organizations and managed care organizations as a measure of physician communication skills. We wanted to compare ratings by real patients with ratings by standardized patients of physician communication. We assessed physician communication using a modified version of the Health Care Climate Questionnaire (HCCQ) among a sample of 100 community physicians. The HCCQ measures physician autonomy support, a key dimension in patient-centered communication. For each physician, the questionnaire was completed by roughly 49 real patients and 2 unannounced standardized patients. Standardized patients portrayed 2 roles: gastroesophageal disorder reflux symptoms and poorly characterized chest pain with multiple unexplained symptoms. We compared the distribution, reliability, and physician rank derived from using real and standardized patients after adjusting for patient, physician, and standardized patient effects. There were real and standardized patient ratings for 96 of the 100 physicians. Compared with standardized patient scores, real-patient-derived HCCQ scores were higher (mean 22.0 vs 17.2), standard deviations were lower (3.1 vs 4.9), and ranges were similar (both 5-25). Calculated real patient reliability, given 49 ratings per physician, was 0.78 (95% confidence interval [CI], 0.71-0.84) compared with the standardized patient reliability of 0.57 (95% CI, 0.39-0.73), given 2 ratings per physician. Spearman rank correlation between mean real patient and standardized patient scores was positive but small to moderate in magnitude, 0.28. Real patient and standardized patient ratings of physician communication style differ substantially and appear to provide different information about physicians' communication style.

"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.

Communication between older women and physicians: Preliminary implications for satisfaction and intention to have mammography

Objective To explore the associations between physician communication styles and their older patients’ intentions to get mammography and satisfaction with physician communication. Methods This cross-sectional mixed methods study was conducted in a teaching hospital outpatient clinic with faculty general internists ( n = 7) and their female patients aged 65 years and older ( n = 56). Audiotaped communication was coded by researchers using the multidimensional interactional analysis and assisted doctor–elderly patient transactions coding systems. Demographic data was collected prior to the visit. Data on intention to have mammography and satisfaction with communication were collected immediately post-visit. Results The majority of encounters had some degree of joint decision-making. Communication styles tended to be associated with women's intentions to have screening mammography. Patients who described communication as “deep”, “trusting” and “bonding” were more satisfied with communication than women who rated physician communication as less trusting ( p = 0.03, 0.02 and 0.02, respectively). Conclusion Physicians’ communication styles affect their older female patients’ satisfaction. In this preliminary study, older women who rated communication as being deep, trusting and bonding tended to have a greater intention to have mammography. Practice implications Improving physicians’ communication styles may increase satisfaction with physician communication and result in higher mammography adherence among older female patients.

Patient Participation in Medical Consultations

Patients vary in their willingness and ability to actively participate in medical consultations. Because more active patient participation contributes to improved health outcomes and quality of care, it is important to understand factors affecting the way patients communicate with healthcare providers. The objectives of this study were to examine the extent to which patient participation in medical interactions is influenced by 1) the patient's personal characteristics (age, gender, education, ethnicity); 2) the physician's communication style (eg, use of partnership-building and supportive talk); and 3) the clinical setting (eg, the health condition, medical specialty). The authors conducted a post hoc cross-sectional analysis of 279 physician-patient interactions from 3 clinical sites: 1) primary care patients in Sacramento, California, 2) patients with systemic lupus erythematosus (SLE) from the San Francisco Bay area, and 3) patients with lung cancer from a VA hospital in Texas. The outcome measures included the degree to which patients asked questions, were assertive, and expressed concerns and the degree to which physicians used partnership-building and supportive talk (praise, reassurance, empathy) in their consultations. The majority of active participation behaviors were patient-initiated (84%) rather than prompted by physician partnership-building or supportive talk. Patients who were more active participants received more facilitative communication from physicians, were more educated, and were more likely to be white than of another ethnicity. Women more willingly expressed negative feelings and concerns. There was considerable variability in patient participation across the 3 clinical settings. Female physicians were more likely to use supportive talk than males, and physicians generally used less supportive talk with nonwhite compared with white patients. Patient participation in medical encounters depends on a complex interplay of personal, physician, and contextual factors. Although more educated and white patients tended to be more active participants than their counterparts, the strongest predictors of patient participation were situation-specific, namely the clinical setting and the physician's communicative style. Physicians could more effectively facilitate patient involvement by more frequently using partnership-building and supportive communication. Future research should investigate how the nuances of individual clinical settings (eg, the health condition, time allotted for the visit) impose constraints or opportunities for more effective patient involvement in care.

‘She gave it her best shot right away’: Patient experiences of biomedical and patient-centered communication

Objective Medical educators and researchers recommend a patient-centered interviewing style, but little empirical data exists regarding what aspects of physician communication patients like and why. We investigated patient responses to videotaped doctor–patient vignettes to ascertain what they liked about patient-centered and biomedical communication. Methods We conducted semi-structured interviews with 230 adult medicine patients who viewed videotapes depicting both patient-centered and biomedical physician communication styles. We used a mixed methods approach to derive a “ground-up” framework of patient communication preferences. Results Respondents who preferred different communication styles articulated different sets of values, important physician behaviors, and physician–patient role expectations. Participants who preferred the patient-centered physician (69%) liked that she worked with and respected patients and explored what the patient wanted. Participants who preferred the biomedical physician (31%) liked that she prevented harm, demonstrated medical authority, and delivered information clearly. Conclusions Patients like (and dislike) patient-centered communication for thoughtful, considered reasons that appear grounded in their values and expectations about physicians, patients, and the clinical encounter. Practice implications Better understanding the diversity of patient communication preferences may lead to more effective and individualized care.

Evaluations of care by adults following a denial of an advertisement-related prescription drug request: The role of expectations, symptom severity, and physician communication style

As patients continue to take a more active role in their health care, an understanding of patient requests of health care providers, including what happens when requests are not fulfilled, is becoming more important. Although its merits have been debated, direct-to-consumer advertising of prescription drugs generates patient requests. The objective of this study was to assess the influence of physician communication style, respondents’ expectations of receiving a requested prescription, and perceived symptom severity on respondents’ evaluations of care following a physician denial of a prescription drug request stimulated by direct-to-consumer advertising. A 2×2×2, between-subjects experimental design was used. The respondents were made up of employees of the University of Mississippi. Physician communication style, respondents’ expectations, and respondents’ perceived symptom severity were manipulated using vignettes. Respondents’ post-visit evaluations of care were assessed by measuring trust in the physician, visit-based satisfaction with the physician, and commitment toward the physician. Factorial analysis of variance procedures for a three-way design were used to test the hypotheses and assess the research questions. Manipulation checks suggested that the independent variables were appropriately manipulated. No significant first-order or second-order interactions were noted in any of the analyses. Post-visit evaluations of care were significantly associated with physician communication style (a partnership response led to better evaluations of care). There were no significant effects of either prior expectation of request fulfillment or perceived symptom severity. However, non-significant trends in mean scores suggested a potential role of these variables in the evaluation process following request denial. The manner in which a physician communicates with an individual is an important determinant of the evaluation of care following the denial of a request. The results suggest that health care providers attempting to minimize the effect of request denials on patient evaluations should make an effort to involve the patient in the decision-making process.

Recipients’ perspective on breaking bad news: How you put it really makes a difference

Objective: The goal of this study was to show that physician communication style of breaking bad news affects how the physician is perceived, how satisfied recipients of bad news are with the consultation, and how they feel after the consultation. Method: Female participants (students, N = 159) were asked to put themselves in the shoes of a patient receiving the bad news of a breast cancer diagnosis. Participants were randomly assigned to watch one of three prototypical physician communication styles of breaking bad news on videotape: patient-, disease-, or emotion-centered communication. Results: Results showed that these three prototypical communication styles were perceived very differently and they determined how satisfied participants were with the consultation and how they felt after the consultation. Participants exposed to the patient-centered communication perceived the physician as most emotional, least dominant, most appropriate when it comes to conveying information, most available and most expressive of hope. Also, they reported to be most satisfied with the visit and they showed the least increase in negative emotions. Conclusion: A patient-centered communication style has the most positive outcome for recipients of bad news on a cognitive, evaluative, and emotional level. Practice implications: Results of this study provide guidelines to physicians on how to convey bad news.

Impact of Physician Sitting Versus Standing During Inpatient Oncology Consultations: Patients' Preference and Perception of Compassion and Duration. A Randomized Controlled Trial

The purpose of this study was to determine the impact of physician sitting versus standing on the patient's preference of physician communication style, and perception of compassion and consult duration. Sixty-nine patients were randomized to watch one of two videos in which the physician was standing and then sitting (video A) or sitting and then standing (video B) during an inpatient consultation. Both video sequences lasted 9.5 minutes. Thirty-five patients (51%) blindly preferred the sitting physician, 16 (23%) preferred the standing, and 18 (26%) had no preference. Patients perceived that their preferred physician was more compassionate and spent more time with the patient when compared with the other physician. There was a strong period effect favoring the second sequence within the video. The patients blinded choice of preference ( P = 0.003), perception of compassion ( P = 0.0016), and other attributes favored the second sequence seen in the video. The significant period effect suggests that patients prefer the second option presented, notwithstanding a stated preference for a sitting posture (55/68, 81%). Physicians should ask patients for their preference regarding physician sitting or standing as a way to enhance communication.

Physician Asthma Education Program Improves Outcomes for Children of Low-Income Families

To determine whether an interactive physician seminar that has been shown to improve patient/parent satisfaction and to decrease emergency department visits for children with asthma was also effective for those children from low-income families. Seventy-four pediatricians and 637 of their patients were randomized to receive two asthma seminars or no educational programs and were observed for 2 years. Physicians in the New York, NY, and Ann Arbor, MI, areas were enrolled, and, on average, 10 patients with asthma per provider were surveyed and observed for 2 years. A total of 637 subjects were enrolled, and 369 subjects remained in the study after 2 years. Of these, 279 had complete medical and survey information. Physicians were randomized, and then a random sample of their patients was enrolled and surveyed regarding the physician's communication style, the child's asthma symptoms, medical needs, and asthma care. Low income was defined as annual income of < 20,000 dollars. The families of 36 children (13%) had an income of < 20,000 dollars, and they were treated by 23 physicians. Low-income children in the treatment group tended to have higher levels of use of controller medications, to receive a written asthma action plan, and to miss fewer days of school, although these differences were not statistically significant compared to low-income children in the control group. However, low-income treatment group children were significantly less likely to be admitted to an emergency department (annual rate, 0.208 vs 1.441, respectively) or to a hospital (annual rate, 0 vs 0.029, respectively) for asthma care compared to children in the control group. The educational program for physicians improved asthma outcomes for their low-income patients. Provider interventions targeted to these high-risk patients may diminish hospital and emergency department asthma care.

Influence of Key Variables on the Patientsʼ Choice of a Physician

Customer orientation is becoming as important in providing health care services as it is in other services. In addition to expecting good health care, patients are also expecting good customer service from their health care providers. Selection of a family physician is a deliberate choice process. This study investigated the variables that influence the choice of a family care physician. This study used an experimental design to investigate the influence of physician's communication style, physician's expertise and role of office staff, appointment availability, etc on the selection of a physician. The results show the significance of physician's expertise and the role of office staff in the choice of a physician.

Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease.

The aim of the study was to investigate the association of physician communication behaviours as perceived by the patient with patient reported satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease in cancer patients. Questionnaires measuring distress, self-efficacy, and perceived control were completed prior to and after the consultation by 454 patients attending an oncology outpatient clinic. After the consultation, the patients also rated the physicians' communicative behaviours by completing a patient–physician relationship inventory (PPRI), and the physicians were asked to estimate patient satisfaction. The overall results showed that higher PPRI scores of physician attentiveness and empathy were associated with greater patient satisfaction, increased self-efficacy, and reduced emotional distress following the consultation. In contrast, lower PPRI scores were associated with reduced ability of the physician to estimate patient satisfaction. The results confirm and expand previous findings, suggesting that communication is a core clinical skill in oncology.

Nurse practitioner and physician communication styles

No empirical studies of nurse-patient relationships have focused on interpersonal communication and its effects on patient outcomes. In this study, 124 provider-patient interactions of five nurse practitioners (NPs) and four physicians (PHYs) were audiotaped. Communication patterns were examined to determine whether the practitioner's predominant style was informational or controlling and whether style affected patient satisfaction and perceived autonomy support. All providers used predominantly informational styles of communication. Significant differences in communication styles existed between provider groups (F = 5.90, df = 1/8, p =.05) and among individual providers (F = 4.28, df = 8/123, p <.0001). All providers were more controlling in their communication patterns when attempting to make decisions and plan patient care. Examination of communication styles can help NPs develop the skills necessary to provide patient-centered care.

The relevance of client-centered communication to family planning settings in developing countries: Lessons from the Egyptian experience

Concern for client's rights in the provision of reproductive health services in the developing world has prompted intense efforts by international experts to promote client-centered models of communication as a replacement for more provider-centered approaches. Nonetheless, the usefulness or feasibility of cross-cultural transplantation of client-centered models of communication has not been examined. The present study examines the feasibility, acceptability, and effectiveness of client-centered models of communication in 31 family planning clinics in Egypt. Consultations between 34 physicians and 112 clients requesting family planning methods were audio-taped and analyzed for physician communication style. Client satisfaction was measured through exit interviews. Method continuation was determined through home interviews at 3 and 7 months from the index visit. Based on audio-tape analysis, two-thirds of physician consultations were characterized as physician-centered and one-third as client-centered. Client-centered consultations were only one minute longer than physician-centered consultations. A client-centered consultation was associated with a three-fold increase in the likelihood of client satisfaction and method continuation at 7 months. A high proportion of solidarity statements (positive talk) by the physician was predictive of client satisfaction whereas a high proportion of disagreement statements and directive instructions by the physician were predictive of method discontinuation. The study findings suggest that in Egypt, as in more developed countries, client-centered models of communication are likely to produce better client outcomes than provider-centered models, with no substantial changes in the structure of services.

Relationship between outpatients’ perceptions of physicians’ communication styles and patients’ anxiety levels in a Japanese oncology setting

For life-threatening illnesses such as cancer that require a long-term treatment regimen, communication is particularly important between doctors and patients. While it is assumed that the more serious the illness, the greater the need to relieve patients’ anxiety, physicians’ communication styles can directly influence patients’ anxiety levels. The purpose of this study was to examine the relationship between outpatients’ perceptions of physicians’ communication styles and the patients’ anxiety levels in oncology settings. Patient anxiety level was measured using the State Trait Anxiety Inventory before and after the consultation. The Perceived Physician's Communication Style Scale was developed in this study. Analysis of responses to the scale resulted in four factors — “acceptive”, “patient-centered”, “attentive”, and “facilitative” — of the physician's communication style and explained 63.7% of the variance. The inter-correlation for overall scale items was 0.95. Patient satisfaction with the medical encounter was also measured to validate the physician's communication style scale. Moderate correlation between the physician's communication style and satisfaction was observed and confirms the relationship between a favorable communication style and a patient's satisfaction. After the consultation, the patients’ anxiety levels dropped 5.0±1.5 points ( p<0.001), and the physician's communication style was shown in many cases to be linked to patient anxiety levels after the consultation. The effect of the physician's communication style on patients’ post-consultation anxiety levels was small among the patients with an advanced disease status. Also, the findings showed that patients’ post-consultation anxiety levels remained low even among those patients with unfavorable examination results if the patients evaluated their physician's communication style as high. This study suggested that the physician's communication style is important not only for moderating patients’ anxiety, but could also be helpful for moderating physicians’ own stress levels when communicating bad news to patients.

Parents’ Perceptions of Physicians’ Communicative Style

Research indicates that parents are under a great deal of stress when a young child is ill and particularly when the child is hospitalized. A key factor in reducing anxiety for parents and children, as well as promoting family‐centered care, is effective communication with the physician and other health educators. This project examined relationships between parent perceptions of their child's physician's communication style and overall satisfaction with him/her. Relationships were examined in the office/clinic and hospital settings. A total of 120 parents participated in the study. The sample was drawn from parents with children attending university‐affiliated childcare centers in a southern US state. Parents who had experienced the hospitalization of a child were less satisfied with their physician during office visits than parents whose children had not been hospitalized. Relationships between the dimensions of physician's communication style and overall satisfaction were also found to differ according to whether the parents had experienced the hospitalization of a child. Children and parents seen in an office/clinic setting may be affected either positively or negatively by previous interactions experienced in the hospital. These interactions may impact health educator's and the primary physician's success in forming positive relationships with the child and family.

Effects of physician communication style on client medication beliefs and adherence with antidepressant treatment

The goals of this study were to examine how physician communication style impacts client beliefs and medication taking behavior during treatment for depression. The study uses a communication framework and prospective design to examine physician communication and client beliefs as treatment is initiated and again 2 months later. Two telephone interviews were conducted with 100 clients enrolled from 23 community pharmacies. Clients report that physician communication styles vary. In follow-up, 25% of the clients were not satisfied with their medication and 82% reported missing doses or stopping treatment earlier than recommended. Path analysis showed that physician initial communication style positively influences client knowledge and initial beliefs about the medication. Clients with more positive beliefs about the treatment are more likely to see the physician in follow-up and are more satisfied with treatment after attempting medication use. Physician follow-up communication style and client satisfaction are both predictive of better medication adherence.

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.

Physicians' Communication Style and Patient Satisfaction

Research has linked the communication styles of physicians to patients' satisfaction with health care. Recently Ben-Sira (1976, 1980) offered a social interaction model to explain this relationship; this model, however, focused on a single, narrow style of communicating and overlooked the broader spectrum of styles. This survey assessed two general communication styles: affiliation and control. It also examined eight social characteristics of medical interviews as possible mediators of the impact of the physician's communication style on the patient's satisfaction. Patients' evaluations of the physician's communication were associated strongly with patients' evaluations of medical care, suggesting that competence in communication may be a facet of medical competence. Affiliative styles were related positively to patients' satisfaction, whereas dominant/active styles had a negative relationship with satisfaction. Severity of the illness, physician's age, physician's specialty, and the number of prior visits affected the importance of the physician's communication in the patient's evaluations of care.

AGE‐RELATED PATIENT PREFERENCES FOR PHYSICIAN COMMUNICATION STYLES

Abstract Previous research in the health communication area has failed to investigate the relationship between patient age and preference for physician communication style. Varying combinations of two styles are explored: information‐dispensing strategies and affective strategies. Multiple comparison procedures indicate that style preferences differ significantly between age groups. While most patients prefer a high degree of both information and affect, older patients prefer a low‐information/high affect strategy. Results may indicate the presence of receiver apprehension in elderly patients. Implications for the preparation of future physicians are explored and discussed.