Physician style shapes satisfaction and outcomes
Taking the patient’s history. Listening to the patient’s medical complaint. Those are basic aspects of primary care medicine. But how physicians ask questions and listen to answers can have significant impact not only on patient satisfaction, but on health outcomes as well, according to recent research.
Here are three key areas of the office visit in which physician style can enhance or hamper communication:
1. Physicians redirect patient concerns within 23 seconds.1
Physicians usually don’t interrupt patients when they’re relating their complaint. But they begin asking follow-up questions on the sore throat before finding out if anything else is bothering the patient.
And since studies show that patients come to the primary care physician with an average of three complaints, physicians may be cutting short the other two, says Kim Marvel, PhD, educational associate director of the Fort Collins (CO) Family Medicine Residency Program.
"Late-arising concerns are more likely when there hasn’t been a complete setting of the agenda early on, which is often called the doorknob phenomenon," says Marvel.
Here’s what doctors said if they wanted to allow patients to state their entire agenda, he says: "Before we explore your sore throat, is there anything else you wanted to talk about?"
Sometimes, physicians worry that an open-ended question like that will bring out more issues than are possible to handle in the office visit. But Marvel says physicians can then ask patients to prioritize, even suggesting a follow-up visit if some less-pressing items can’t be addressed that day. "It’s very overtly negotiated," he says. "There’s a negotiation and prioritizing, then you move on."
Because most physicians don’t realize how quickly they cut off patients from relating all their concerns, changing behavior takes some work, says Marvel. He recommends continuing medical education in interview skills, followed by real-time feedback.
"With our own residents, you can talk to them and explain [the skill], and then observe them and they won’t do it," says Marvel. Only by hearing comments immediately following an interaction can they learn to integrate the technique, he says.
2. A physician practice style that emphasizes psychosocial aspects of care leads to better health outcomes.2
When office visits include more psychosocial talk, patients actually report a better health status, according to a study by Klea Bertakis, MD, MPH, professor and chair of the department of family and community medicine at the University of California, Davis, in Sacramento. In addition, an increased technical style was linked to decreased patient satisfaction.
Bertakis and her colleagues randomly assigned 509 patients to physicians at a family practice or internal medicine clinic and followed them for one year of care. Practice type didn’t make a difference, but practice style did, she says.
The technical aspect of care is clearly important in diagnosing and treating illness. But when physicians also integrated counseling into the visit, such as asking about the patient’s emotional well-being or interpersonal relationships, patients showed more improvement in health status.
That points to an area for continuing medical education, she says. "You can learn how to take a good psychosocial history, how to ask the right questions, and respond in ways that are appropriate," she says.
3. When patients are activated to become involved in their own medical care, they have higher satisfaction.2
In the same study, "patient activation" — encouraging patients to ask questions and share their opinions — led to greater patient satisfaction.
Because high satisfaction is also linked to improvements in health status, patient activation also influences health outcomes, says Bertakis.
"We can involve patients in their own health care," she says. "We can figure out what they know about their illness, negotiating with them and getting them more actively involved. They perceive that as being more satisfying, and it can be associated with better health outcomes."
References
1. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: Have we improved? JAMA 1999; 281:283-287.
2. Bertakis KD, Callahan EJ, Helms LJ, Azari R, et al. Physician practice styles and patient outcomes. Med Care 1998; 36:879-891.
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