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Liddell SS, Tomasi AG, Halvorsen AJ, Stelling BEV, Leasure EL. Gender Disparities in Electronic Health Record Usage and Inbasket Burden for Internal Medicine Residents. J Gen Intern Med 2024:10.1007/s11606-024-08861-0. [PMID: 38926324 DOI: 10.1007/s11606-024-08861-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Studies have demonstrated patients hold different expectations for female physicians compared to male physicians, including higher expectations for patient-centered communication and addressing socioeconomic or emotional needs. Recent evidence indicates this gender disparity extends to the electronic health record (EHR). Similar studies have not been conducted with resident physicians. OBJECTIVE This study seeks to characterize differences in EHR workload for female resident physicians compared to male resident physicians. DESIGN This study evaluated 12 months of 156 Mayo Clinic internal medicine residents' inbasket data from July 2020 to June 2021 using Epic's Signal and Physician Efficiency Profile (PEP) data. Excel, BlueSky Statistics, and SAS analytical software were used for analysis. Paired t-tests and analysis of variance were used to compare PEP data by gender and postgraduate year (PGY). "Male" and "female" were used in substitute for "gender" as is precedent in the literature. SUBJECTS Mayo Clinic internal medicine residents. MAIN MEASURES Total time spent in EHR per day; time in inbasket and notes per day; time in notes per appointment; number of patient advice requests made through the portal; message turnaround time. KEY RESULTS Female residents received more patient advice requests per year (p = 0.004) with an average of 86.7 compared to 68, resulting in 34% more patient advice requests per day worked (p < 0.001). Female residents spent more time in inbasket per day (p = 0.002), in notes per day (p < 0.001), and in notes per appointment (p = 0.001). Resident panel comparisons revealed equivocal sizes with significantly more female patients on female (n = 55) vs male (n = 34) resident panels (p < 0.001). There was no difference in message turnaround time, total messages, or number of results received. CONCLUSIONS Female resident physicians experience significantly more patient-initiated messages and EHR workload despite equivalent number of results and panel size. Gender differences in inbasket burden may disproportionally impact the resident educational experience.
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Affiliation(s)
- Savannah S Liddell
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Andrew J Halvorsen
- Office of Educational Innovations, Internal Medicine Residency Program, Mayo Clinic, Rochester, MN, USA
| | - Brianna E Vaa Stelling
- Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA
| | - Emily L Leasure
- Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA.
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Gemmiti M, Hamed S, Wildhaber J, Pharisa C, Klumb PL. Physicians' Speech Complexity and Interrupting Behavior in Pediatric Consultations. HEALTH COMMUNICATION 2022; 37:748-759. [PMID: 33441020 DOI: 10.1080/10410236.2020.1868063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Pediatricians' communication behavior affects a variety of outcomes in both children and their parents. This study analyzes how speech complexity and interruptions as indicators of accommodative behaviors relate to parental recall of medical information and to their satisfaction with the medical encounter. We recruited 19 pediatricians and 68 parents at pediatric inpatient and outpatient consultations in two Swiss clinics. All medical interactions were videotaped and transcripts were analyzed to assess pediatricians' speech complexity and interrupting behavior was coded from the videos. At the end of the encounter, parents rated their satisfaction with the medical encounter and were probed regarding their recall of medical information. Our results show recall of medical information to be unrelated to pediatricians' speech complexity and negatively associated with their interrupting behavior for parents who report low positive mood. We also found less educated parents to report lower satisfaction when pediatricians employed more complex language. Furthermore, parental satisfaction was negatively associated with pediatricians' interrupting behavior, especially when displayed by male pediatricians. Overall, these findings suggest that pediatricians' speech complexity and interruptions indicate a nonaccommodative stance reducing advantageous parent outcomes.
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Affiliation(s)
| | - Selei Hamed
- Department of Pediatrics, Faculty of Science and Medecine, Hospital Fribourg, University of Fribourg
| | - Johannes Wildhaber
- Department of Pediatrics, Faculty of Science and Medecine, Hospital Fribourg, University of Fribourg
| | - Cosette Pharisa
- Department of Pediatrics, Faculty of Science and Medecine, Hospital Fribourg, University of Fribourg
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Renier LA, Schmid Mast M, Dael N, Kleinlogel EP. Nonverbal Social Sensing: What Social Sensing Can and Cannot Do for the Study of Nonverbal Behavior From Video. Front Psychol 2021; 12:606548. [PMID: 34385943 PMCID: PMC8353184 DOI: 10.3389/fpsyg.2021.606548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
The study of nonverbal behavior (NVB), and in particular kinesics (i.e., face and body motions), is typically seen as cost-intensive. However, the development of new technologies (e.g., ubiquitous sensing, computer vision, and algorithms) and approaches to study social behavior [i.e., social signal processing (SSP)] makes it possible to train algorithms to automatically code NVB, from action/motion units to inferences. Nonverbal social sensing refers to the use of these technologies and approaches for the study of kinesics based on video recordings. Nonverbal social sensing appears as an inspiring and encouraging approach to study NVB at reduced costs, making it a more attractive research field. However, does this promise hold? After presenting what nonverbal social sensing is and can do, we discussed the key challenges that researchers face when using nonverbal social sensing on video data. Although nonverbal social sensing is a promising tool, researchers need to be aware of the fact that algorithms might be as biased as humans when extracting NVB or that the automated NVB coding might remain context-dependent. We provided study examples to discuss these challenges and point to potential solutions.
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Affiliation(s)
- Laetitia Aurelie Renier
- Department of Organizational Behavior - Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland
| | - Marianne Schmid Mast
- Department of Organizational Behavior - Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland
| | - Nele Dael
- Department of Organizational Behavior - Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland
| | - Emmanuelle Patricia Kleinlogel
- Department of Organizational Behavior - Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland
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Chekijian S, Kinsman J, Taylor RA, Ravi S, Parwani V, Ulrich A, Venkatesh A, Agrawal P. Association between patient-physician gender concordance and patient experience scores. Is there gender bias? Am J Emerg Med 2020; 45:476-482. [PMID: 33069544 DOI: 10.1016/j.ajem.2020.09.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patient satisfaction, a commonly measured indicator of quality of care and patient experience, is often used in physician performance reviews and promotion decisions. Patient satisfaction surveys may introduce gender-related bias. OBJECTIVE Examine the effect of patient and physician gender concordance on patient satisfaction with emergency care. METHODS We performed a cross-sectional analysis of electronic health record and Press Ganey patient satisfaction survey data of adult patients discharged from the emergency department (2015-2018). Logistic regression models were used to examine relationships between physician gender, patient gender, and physician-patient gender dyads. Binary outcomes included: perfect care provider score and perfect overall assessment score. RESULTS Female patients returned surveys more often (n=7 612; 61.55%) and accounted for more visits (n=232 024; 55.26%). Female patients had lower odds of perfect scores for provider score and overall assessment score (OR: 0.852, 95% CI: 0.790, 0.918; OR: 0.782, 95% CI: 0.723, 0.846). Female physicians had 1.102 (95% CI: 1.001, 1.213) times the odds of receiving a perfect provider score. Physician gender did not influence male patients' odds of reporting a perfect care provider score (95% CI: 0.916, 1.158) whereas female patients treated by female physicians had 1.146 times the odds (95% CI: 1.019, 1.289) of a perfect provider score. CONCLUSION Female patients prefer female emergency physicians but were less satisfied with their physician and emergency department visit overall. Over-representation of female patients on patient satisfaction surveys introduces bias. Patient satisfaction surveys should be deemphasized from physician compensation and promotion decisions.
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Affiliation(s)
- Sharon Chekijian
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Jeremiah Kinsman
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shashank Ravi
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; Stanford University School of Medicine, USA
| | - Vivek Parwani
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew Ulrich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Arjun Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Mast MS, Kadji KK. How female and male physicians' communication is perceived differently. PATIENT EDUCATION AND COUNSELING 2018; 101:1697-1701. [PMID: 29903628 DOI: 10.1016/j.pec.2018.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/09/2018] [Accepted: 06/06/2018] [Indexed: 05/14/2023]
Abstract
OBJECTIVE This paper is based on a 2017 Baltimore International Conference on Communication in Healthcare (ICCH) plenary presentation by the first author and addresses how female and male physicians' communication is perceived and evaluated differently. Female physicians use patient-centered communication which is the interaction style clearly preferred by patients. Logically, patients should be much more satisfied with female than male physicians. However, research shows that this is not the case. METHODS This article provides an overview on how female and male physician communication is evaluated and perceived differently by patients and discusses whether and how gender stereotypes can explain these differences in perception and evaluation. RESULTS Male physicians obtain good patient outcomes when verbally expressing patient-centeredness while female physicians have patients who report better outcomes when they adapt their nonverbal communication to the different needs of their patients. CONCLUSION The analysis reveals that existing empirical findings cannot simply be explained by the adherence or not to gender stereotypes. Female physicians do not always get credit for showing gender role congruent behavior. All in all, female and male physicians do not obtain credit for the same behaviors. PRACTICE IMPLICATIONS Physician communication training might put different accents for female and male physicians.
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Affiliation(s)
| | - Keou Kambiwa Kadji
- Department of Organizational Behavior, University of Lausanne, Switzerland
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Linzer M, Harwood E. Gendered Expectations: Do They Contribute to High Burnout Among Female Physicians? J Gen Intern Med 2018; 33:963-965. [PMID: 29435727 PMCID: PMC5975148 DOI: 10.1007/s11606-018-4330-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/21/2017] [Accepted: 01/10/2018] [Indexed: 11/26/2022]
Abstract
Patients have differing expectations of female versus male physicians. Female patients tend to seek more empathic listening and longer visits, especially with female physicians; however, female doctors are not provided more time for this. Female doctors have more female patients than male doctors, and more patients with psychosocial complexity. We propose that gender differences in patient panels and gendered expectations of female physicians may contribute to the high rate of burnout among female clinicians, as well as to the many female physicians working part-time to reduce stress in their work lives. We propose several mechanisms for addressing this, including brief increments in visit time (20, 30 and 40 min), staff awareness, training in patient expectations during medical school, adjusting for patient gender in compensation plans, and co-locating behavioral medicine specialists in primary care settings. Beneficial outcomes could include fewer malpractice suits, greater patient satisfaction, higher quality care, and lower burnout among female physicians.
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Affiliation(s)
- Mark Linzer
- Division of General Internal Medicine, Office of Professional Worklife, Hennepin County Medical Center, Minneapolis, MN USA
| | - Eileen Harwood
- School of Public Health, University of Minnesota, Minneapolis, MN USA
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Bernecker K, Ghassemi M, Brandstätter V. Approach and avoidance relationship goals and couples’ nonverbal communication during conflict. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2018. [DOI: 10.1002/ejsp.2379] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Katharina Bernecker
- Leibniz‐Institut für Wissensmedien Tübingen Germany
- Department of Psychology University of Zurich Zurich Switzerland
| | - Mirjam Ghassemi
- Department of Psychology University of Zurich Zurich Switzerland
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8
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Kraft-Todd GT, Reinero DA, Kelley JM, Heberlein AS, Baer L, Riess H. Empathic nonverbal behavior increases ratings of both warmth and competence in a medical context. PLoS One 2017; 12:e0177758. [PMID: 28505180 PMCID: PMC5432110 DOI: 10.1371/journal.pone.0177758] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 05/03/2017] [Indexed: 01/10/2023] Open
Abstract
In medicine, it is critical that clinicians demonstrate both empathy (perceived as warmth) and competence. Perceptions of these qualities are often intuitive and are based on nonverbal behavior. Emphasizing both warmth and competence may prove problematic, however, because there is evidence that they are inversely related in other settings. We hypothesize that perceptions of physician competence will instead be positively correlated with perceptions of physician warmth and empathy, potentially due to changing conceptions of the physician’s role. We test this hypothesis in an analog medical context using a large online sample, manipulating physician nonverbal behaviors suggested to communicate empathy (e.g. eye contact) and competence (the physician’s white coat). Participants rated physicians displaying empathic nonverbal behavior as more empathic, warm, and more competent than physicians displaying unempathic nonverbal behavior, adjusting for mood. We found no warmth/competence tradeoff and, additionally, no significant effects of the white coat. Further, compared with male participants, female participants perceived physicians displaying unempathic nonverbal behavior as less empathic. Given the significant consequences of clinician empathy, it is important for clinicians to learn how nonverbal behavior contributes to perceptions of warmth, and use it as another tool to improve their patients’ emotional and physical health.
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Affiliation(s)
- Gordon T. Kraft-Todd
- Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychology, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
| | - Diego A. Reinero
- Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychology, New York University, New York, New York, United States of America
| | - John M. Kelley
- Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychology, Endicott College, Beverly, Massachusetts, United States of America
| | - Andrea S. Heberlein
- Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychology, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - Lee Baer
- Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
| | - Helen Riess
- Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
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Carrard V, Schmid Mast M, Cousin G. Beyond "One Size Fits All": Physician Nonverbal Adaptability to Patients' Need for Paternalism and Its Positive Consultation Outcomes. HEALTH COMMUNICATION 2016; 31:1327-33. [PMID: 27030260 DOI: 10.1080/10410236.2015.1052871] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
In this study, we tested whether physicians' ability to adapt their nonverbal behavior to their patients' preferences for a paternalistic interaction style is related to positive consultation outcomes. We hypothesized that the more physicians adapt their nonverbal dominance behavior to match their patients' preferences for physician paternalism, the more positively the patients perceive the medical interaction. We assessed the actual nonverbal dominance behavior of 32 general practitioners when interacting with two of their patients and compared it with each of their patients' preferences for paternalism to obtain a measure of adaptability. Additionally, we measured patient outcomes with a questionnaire assessing patient satisfaction, trust in the physician, and evaluation of physician competence. Results show that the more nonverbal dominance the physician shows toward the patient who prefers a more paternalistic physician, as compared to toward the patient who prefers a less paternalistic physician (i.e., the more the physician shows nonverbal behavioral adaptability), the more positive the consultation outcomes are. This means that physicians' ability to adapt aspects of their nonverbal dominance behavior to their individual patients' preferences is related to better outcomes for patients. As this study shows, it is advantageous for patients when a physician behaves flexibly instead of showing the same behavior towards all patients. Physician training might want to focus more on teaching a diversity of different behavior repertoires instead of a given set of behaviors.
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Affiliation(s)
- Valérie Carrard
- a Department of Organizational Behavior , University of Lausanne , Lausanne , Switzerland
| | - Marianne Schmid Mast
- a Department of Organizational Behavior , University of Lausanne , Lausanne , Switzerland
| | - Gaëtan Cousin
- b Institute of Work and Organizational Psychology, University of Neuchâtel , Neuchâtel , Switzerland
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Cousin G, Schmid Mast M. Trait-agreeableness influences individual reactions to a physician's affiliative behavior in a simulated bad news delivery. HEALTH COMMUNICATION 2015; 31:320-327. [PMID: 26305190 DOI: 10.1080/10410236.2015.1007827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We tested whether the personality trait of agreeableness predicts different individual reactions to the level of nonverbal affiliativeness shown by a physician, in the context of a simulated bad news delivery. We predicted that individuals with high levels of agreeableness would react better to a physician adopting a highly affiliative communication style compared to individuals with low levels of agreeableness. We used an experimental design with analogue patients. Eighty participants (40 men/40 women) were randomly assigned to watch a video of a physician who communicated a bad diagnosis either in a highly affiliative or in a less affiliative way. Participants reported their reactions of anger and trust in the physician, and completed the agreeableness scale of the NEO Five-Factor Inventory (NEO-FFI). In accordance with our predictions, the higher the agreeableness score of the participants, the less anger and the more trust they reported after viewing the high as compared to the low affiliative physician. These results suggest that people with high levels of agreeableness may be especially sensitive to highly affiliative physician nonverbal behavior when receiving bad news.
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Affiliation(s)
| | - Marianne Schmid Mast
- b Department of Organizational Behavior, Faculty of Business and Economics , University of Lausanne
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Dijkstra H, Albada A, Klöckner Cronauer C, Ausems MGEM, van Dulmen S. Nonverbal communication and conversational contribution in breast cancer genetic counseling: are counselors' nonverbal communication and conversational contribution associated with counselees' satisfaction, needs fulfillment and state anxiety in breast cancer genetic counseling? PATIENT EDUCATION AND COUNSELING 2013; 93:216-223. [PMID: 23786807 DOI: 10.1016/j.pec.2013.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/28/2013] [Accepted: 05/19/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The current study aimed to examine how counselors' nonverbal communication (i.e. nonverbal encouragements and counselee-directed eye gaze) and conversational contribution (i.e. verbal dominance and interactivity) during the final visit within breast cancer genetic counseling relate to counselee satisfaction, needs fulfillment and anxiety. METHODS Breast cancer counselees (N=85) completed questionnaires measuring satisfaction, needs fulfillment and anxiety after the final consultation and anxiety before the initial visit. Consultations were videotaped. Counselor nonverbal encouragements and counselee-directed eye gaze were coded. Verbal dominance and interactivity were measured using the Roter Interaction Analysis System (RIAS). RESULTS More counselor nonverbal encouragements and higher counselor verbal dominance were both significantly related to higher post-visit anxiety. Furthermore, counselor verbal dominance was associated with lower perceived needs fulfillment. No significant associations with eye gaze and interactivity were found. CONCLUSION More research is needed on the relationship between nonverbal encouragements and anxiety. Given the unfavorable association of counselor verbal dominance with anxiety and needs fulfillment, more effort could be devoted to involve counselees in the dialog and reduce the counselor's verbal contribution during the consultation. PRACTICE IMPLICATIONS Interventions focused on increasing counselees' contribution in the consultation may be beneficial to counselees.
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Affiliation(s)
- Henriëtta Dijkstra
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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12
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Cousin G, Schmid Mast M, Jaunin-Stalder N. When physician-expressed uncertainty leads to patient dissatisfaction: a gender study. MEDICAL EDUCATION 2013; 47:923-931. [PMID: 23931541 DOI: 10.1111/medu.12237] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/21/2013] [Accepted: 03/15/2013] [Indexed: 06/02/2023]
Abstract
CONTEXT Communication guidelines often advise physicians to disclose to their patients medical uncertainty regarding the diagnosis, origin of the problem, and treatment. However, the effect of the expression of such uncertainty on patient outcomes (e.g. satisfaction) has produced conflicting results in the literature that indicate either no effect or a negative effect. The differences in the results of past studies may be explained by the fact that potential gender effects on the link between physician-expressed uncertainty and patient outcomes have not been investigated systematically. OBJECTIVES On the basis of previous research documenting indications that patients may judge female physicians by more severe criteria than they do male physicians, and that men are more prejudiced than women towards women, we predicted that physician-expressed uncertainty would have more of a negative impact on patient satisfaction when the physician in question was female rather than male, and especially when the patient was a man. METHODS We conducted two studies with complementary designs. Study 1 was a randomised controlled trial conducted in a simulated setting (120 analogue patients Analogue patients are healthy participants asked to put themselves in the shoes of real medical patients by imagining being the patients of physicians shown on videos); Study 2 was a field study conducted in real medical interviews (36 physicians, 69 patients). In Study 1, participants were presented with vignettes that varied in terms of the physician's gender and physician-expressed uncertainty (high versus low). In Study 2, physicians were filmed during real medical consultations and the level of uncertainty they expressed was coded by an independent rater according to the videos. In both studies, patient satisfaction was assessed using a questionnaire. RESULTS The results confirmed that expressed uncertainty was negatively related to patient satisfaction only when the physician was a woman (Studies 1 and 2) and when the patient was a man (Study 2). CONCLUSIONS We believe that patients have the right to be fully informed of any medical uncertainties. If our results are confirmed in further research, the question of import will refer not to whether female physicians should communicate uncertainty, but to how they should communicate it. For instance, if it proves true that uncertainty negatively impacts on (male) patients' satisfaction, female physicians might want to counterbalance this impact by emphasizing other communication skills.
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Affiliation(s)
- Gaetan Cousin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX4 1SZ, UK.
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13
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The validity of using analogue patients in practitioner-patient communication research: systematic review and meta-analysis. J Gen Intern Med 2012; 27:1528-43. [PMID: 22700392 PMCID: PMC3475831 DOI: 10.1007/s11606-012-2111-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 04/11/2012] [Accepted: 05/03/2012] [Indexed: 12/04/2022]
Abstract
When studying the patient perspective on communication, some studies rely on analogue patients (patients and healthy subjects) who rate videotaped medical consultations while putting themselves in the shoes of the video-patient. To describe the rationales, methodology, and outcomes of studies using video-vignette designs in which videotaped medical consultations are watched and judged by analogue patients. Pubmed, Embase, Psychinfo and CINAHL databases were systematically searched up to February 2012. Data was extracted on: study characteristics and quality, design, rationales, internal and external validity, limitations and analogue patients' perceptions of studied communication. A meta-analysis was conducted on the distribution of analogue patients' evaluations of communication. Thirty-four studies were included, comprising both scripted and clinical studies, of average-to-superior quality. Studies provided unspecific, ethical as well as methodological rationales for conducting video-vignette studies with analogue patients. Scripted studies provided the most specific methodological rationales and tried the most to increase and test internal validity (e.g. by performing manipulation checks) and external validity (e.g. by determining identification with video-patient). Analogue patients' perceptions of communication largely overlap with clinical patients' perceptions. The meta-analysis revealed that analogue patients' evaluations of practitioners' communication are not subject to ceiling effects. Analogue patients' evaluations of communication equaled clinical patients' perceptions, while overcoming ceiling effects. This implies that analogue patients can be included as proxies for clinical patients in studies on communication, taken some described precautions into account. Insights from this review may ease decisions about including analogue patients in video-vignette studies, improve the quality of these studies and increase knowledge on communication from the patient perspective.
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Shaw JR, Bonnett BN, Roter DL, Adams CL, Larson S. Gender differences in veterinarian-client-patient communication in companion animal practice. J Am Vet Med Assoc 2012; 241:81-8. [PMID: 22720991 DOI: 10.2460/javma.241.1.81] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jane R Shaw
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.
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