A systematic literature review was undertaken in October to begin to understand what is known about the doctor–patient relationship and. International Cardiovascular Forum Journal 3 (). DOI: /icfj.v3i0. physician-patient relationship. the development of widely available patient . Houston tK, sands dZ, Jenckes Mw, Ford de. experiences of patients who were early. Objective: The goal of this study was to (1) explore the relationship between medical utilization and characteristics of the patient-physician relationship and (2 ).
Develop strategies to increase workplace efficiency, leaving time for physicians to explain their reasoning, to know patients, and to establish rapport; by using prescreening forms and questionnaires while the patient is in the waiting room or by using simple technologies eg, walkie-talkies to communicate with medical assistants and other support staffmore time can be devoted to patient care 42 Knowledge: There is less time for the physician and the patient to get to know one another Regard: There is less time to establish rapport Loyalty: If the space is not private, physicians may be reluctant to ask certain questions, which limit their ability to know the patient; additionally, patients may be reluctant to confide in doctors if they do not feel the conversation is private Knowledge: Whenever possible, take the patient into a private room to ask questions Regard: Busy and uncomfortable clinics may make it harder for the doctor and patient to connect High patient-provider ratioa Knowledge: Patients may feel like they are objects being discussed, rather than as equals participating in their own care; they may not feel as though they know all of the team members and what their roles are Trust: There may be too many people with whom to establish rapport Knowledge and regard: Whenever possible, limit the number of physicians who round on a patient at one time; in teaching hospitals, where this is not always possible, team members should introduce themselves to the patient outside of rounds to establish rapport and to know the patient Urgent care setting eg, emergency department, clinic Knowledge: The doctor and the patient may not know each other Knowledge: The patient and the physician may be less inclined to invest effort in establishing rapport if they know they will not see each other again Regard: Take the time to establish rapport and to make the patient feel comfortable whenever possible Loyalty: Clinics may not be set up for longitudinal care eg, in the emergency department Loyalty: Set up follow-up appointments with established providers before discharging the patient Cost Regard: The patient may harbor resentment about medical bills Knowledge: The patient may be reluctant to see a doctor due to financial concerns Documentation burden Knowledge: Physicians may spend much of the visit making sure all the necessary computer boxes are checked rather than getting to know the patient as a person; having a computer between the patient and the doctor also makes it hard for the patient to feel like he or she knows the doctor Several time-saving strategies can be employed to reduce the amount of time spent on documentation and increase the time available for physicians to spend with patients Embrace technology: Physicians may spend much of the visit facing the computer screen rather than the patient, which may make the patient feel as though the doctor does not care about him or her as a person; the amount of paperwork and documentation that is often required also enhances physician burnout, making it harder for the physician to demonstrate empathy and caring Use dictation software to speed note-writing When appropriate, write a note collaboratively with the patient during the visit; if using this approach, either turn the screen so that the patient can see it as well or arrange seats so that the physician can maintain eye contact with the patient while he or she is typing the notes aRefers specifically to teaching rounds, wherein a large team of providers visits a patient as a group.
Attentive doctors are better able to understand both verbal and nonverbal communication 28 ; therefore, burnout, which hinders attentiveness, prevents physicians from appreciating the needs of their patients, thus failing to identify their ailments Regard: It is harder for emotionally exhausted physicians to show affection; when physicians are burned out, their patients are more likely to report that physicians use nonempathic statements 26 Loyalty: It was also expected that physicians would perceive patients with somatization tendencies as more difficult than patients with many medical problems.
Before each business day, a research assistant and the nurses responsible for scheduling patients identified potential study participants by using the billing database: The research assistant contacted eligible patients individually in the examination room prior to their interaction with the physician to ascertain interest in study participation and to obtain consent.
Eligible patients were contacted in a way that did not interrupt the normal flow of patients in the office.
The Patient-Physician Relationship and Medical Utilization
Patients completed the questionnaires after seeing their physician. The instruments required approximately 10 minutes total to complete. The physician seeing the patient completed the Difficult Doctor-Patient Relationship Questionnaire 11 to describe his or her reactions following the encounter with the patient.
The policy of the center was for the continuity physician to see his or her patient for all visits; however, if the continuity physician was not seeing patients that day, another physician would see the patient for the acute problem. Most of the subjects were seeing their own physicians, although we did not gather data on the specific number.
Since patients had to be in the practice for at least a year to be considered for the study, it is likely that the specific patient-physician relationship had existed for at least that long. The number of office visits and phone calls to the office during the previous year, chronic problems e. Chart reviews were done by a research assistant, who was trained and supervised by the physician-author E.
The research assistant was trained using a standardized data recording form. Informed Consent The procedures followed were in accord with appropriate ethical principles and were approved by the Institutional Review Board of the Medical College of Ohio now the University of Toledo. After a complete description of the study was given to subjects, written informed consent was obtained.
Instruments The PRIME-MD Patient Questionnaire 13 is a screening instrument for primary care settings through which patients report symptoms of mood disturbance, anxiety, eating disorder, somatization disorder, and alcohol use.
Validation was demonstrated by the agreement between questionnaire responses and assessments done by mental health professionals. Of particular interest in this study were the 15 physical symptoms suggestive of a somatization disorder.
The subscale scores can range from 8 to Analysis Descriptive statistics were calculated from patients completing the inventories. Independent t tests were used to determine the effects of demographic variables on outcome measures. Pearson product moment correlation coefficients were calculated to examine the relationship between the continuous variables.
Impact of the Doctor-Patient Relationship
The mean age was Forty-three patients refused to participate, largely due to time constraints. Since they did not become subjects, we were not able to collect demographic information on them to determine how they might be different from study subjects. Gender, marital status, education, and employment status were related to other study measures.
Additional demographic information for patient subjects can be found in Table 1. Open in a separate window Thirteen resident 7 women, 6 men and 7 faculty 1 woman, 6 men physicians completed the Difficult Doctor-Patient Relationship Questionnaire on these patients following the encounter.
The mean SD number of visits to the center by patient subjects for the year prior to the study was 5. The mean SD number of telephone calls for the same time period was 4. Patients had a mean SD of Means and standard deviations for these and all study variables can be found in Table 2.
- The Patient-Physician Relationship and Medical Utilization
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None of the patient rating scores on the Barrett-Lennard Relationship Inventory correlated significantly with other study variables, although they did correlate significantly with one another range, 0. A complete listing of correlations among study variables can be found in Table 3. Open in a separate window A linear multiple regression analysis was performed including 3 variables number of office visits, number of phone calls, and PRIME-MD somatization scores that were significantly correlated with the physician's perception of the relationship.
The goal was to ascertain whether each of these variables would independently predict the physician's perception of the relationship. R2 for the multiple linear regression analysis was 0. Results of the analysis of variance can be found in Table 4.
From the multiple regression analysis, we found that a somatizing personality condition influenced the rating of patient difficulty more than either the number of visits the patient scheduled or the number of times the patient called the office.
Telephone calls were independently predictive of perceived patient difficulty but not to the same degree as somatization.
Our findings also suggest that some demographic variables may be associated with utilization and physician perception of difficulty. As a group, unmarried women with less formal education are highest in medical utilization and perceived degree of difficulty by their physicians. The first hypothesis was partially supported by the results of this study.
Patients rated as more difficult by their physicians did make significantly more frequent visits and phone calls to the office. However, patient ratings of the physician's warmth, understanding, or honesty were not associated with medical utilization. Results of the study supported the second hypothesis. Physicians considered patients who scored higher on the somatization scale as more difficult, but not those patients with a greater number of chronic problems listed in their charts.
This would support the assertions 7 that somatization tendencies and multiple nonspecific complaints compared to actual chronic physical problems lead to greater difficulty in the relationship, at least from the physician's perspective. It appears from our results that somatization influences the physician's perception of the relationship more than phone calls or office visits which was not an independent predictor of the relationship. The patient who somatizes presents a special mental health challenge to the primary care physician, but the psychiatric diagnostic system has not been particularly helpful.
This would suggest that physicians are not unduly influenced by patient somatizing tendencies in their prescribing practices. Another intriguing finding was that number of chronic problems was positively associated with telephone calls to the practice, but somatizing tendencies were not. Both number of chronic problems and somatizing tendencies were positively associated with office visits.
It may be that personal contact is relatively more important to the somatizing patient, and that the telephone call would not be as satisfying. Further research in this area would be helpful. The association found between demographic variables and other study variables deserves additional comment.
Impact of the Doctor-Patient Relationship
The relationship between gender and reports of physical symptoms has been previously reported, 17 with women more likely to admit medical problems and to seek help for them. Marital status, especially for men, has also been associated with better health status, 18 and the social support possible through marriage may be the mechanism.
More educated patients had fewer medical problems and made fewer visits. The influence of education on health status has been reported previously.