Specialist Physicians’ Sensitivity to Patient Affect and Satisfaction

Patient affect, physician liking for the patient, physician behavior, and patient reported outcomes: A modeling approach

OBJECTIVE

To determine associations between patient affect and physician liking of the patient, and their associations with physician behavior and patient-reported outcomes.

METHODS

Structural equation modeling based on coding of 497 videotaped hospital encounters, with questionnaires assessing pre-visit patient affect, post-visit patient affect and encounter evaluations, and physician liking of the patient, involving 71 physicians.

RESULTS

In first visits, patient reported outcomes were strongly correlated with physician behavior and less so with physician liking, while in later visits, patient reported outcomes were directly related to physician liking and not mediated by physician behavior. Physician liking predicted physician behavior, more for female physicians in first visits. Patient negative affect before the visit was negatively associated with male physicians' liking. When acquainted, both patient positive and negative affect were associated with physician liking.

CONCLUSION

Physician liking of the patient plays a dynamic role in a consultation, is influenced by patient pre-encounter affect, and influences physician behavior. The dynamics are different in first and later visits, and influenced by physician gender.

PRACTICE IMPLICATIONS

Physicians should be aware how patient affect influences their behavior, and administrators should take any prior relationship between patient and physician into account when evaluating patient reported outcomes.

The perils of information giving: What an accidental incident taught us about messages and roles

INTRODUCTION

Occasionally mishaps in an investigation lead to new understandings. We report how a videotaped emotional discussion among a family after they had received information about their relative's state gave us insight into the minute sources of uncertainty that fueled their confusion.

METHODS

Based on the themes of the family's discussion, we used a forensic approach to locate distinct sequences of interest in the video and transcript. Microanalysis of face-to-face dialogue was performed to understand the most critical sequence. The analysis was supported by questionnaire data.

RESULTS

The family's disagreement about the patient's prognosis could be traced to minor differences in how the surgeon and the anesthesiologist had framed the information. In attempting to resolve apparent contradictions, the family realized they were uncertain about the physicians' roles, which amplified the emotional expressions in the discussions. Role confusion could be traced to subtle details in the surgeon's presentation of himself and the surgery.

CONCLUSION

Minor discrepancies in how health care professionals frame information combined with not exploring relatives' emotions may lead to major differences in relatives' perceptions. Doubt about health providers' roles decontextualizes information and reassurance, magnifying uncertainty.

PRACTICE IMPLICATIONS

Health providers should present themselves clearly without haste. If more than one provider is involved, joint preparation of the main messages may be necessary.

Determinants and influencing mechanism of outpatient satisfaction: a survey on tertiary hospitals in the People's Republic of China

OBJECTIVE

Most patients in the People's Republic of China prefer tertiary hospitals when seeking medical services. The aim of this study was to assess outpatient satisfaction with tertiary hospitals in the People's Republic of China, test overall and subscale satisfaction, and explore whether sociodemographic characteristics lead to different degrees of satisfaction and whether subscale outpatient satisfaction contributes to overall satisfaction.

METHODS

A closed questionnaire was given out to investigate outpatients' sociodemographic characteristics, overall satisfaction, and various subtypes of satisfaction, and a 5-point Likert scale was employed to measure the degree of outpatient satisfaction. Descriptive analysis, Kruskal-Wallis test, Spearman's rank correlation coefficient, and logistic regression analysis were employed for statistical analysis.

RESULTS

Response rate was 92.48% (971/1,050). Outpatients' sociodemographic characteristics (including sex, age, occupation, monthly income, residence, and marital status) were related to various subtypes of satisfaction to varying degrees. Outpatients who were male, older, married, with low or middle incomes, living in Shanghai or other areas of the People's Republic of China, medical staff, or students were more satisfied with various subtypes of satisfaction than those without these characteristics. In further analyses, satisfaction with their medical needs being met by doctors had the strongest relation to overall satisfaction, followed by satisfaction with doctors' service attitudes, medical costs, waiting time, prescription, and diagnosis and treatment time. Satisfaction with environment had the weakest contribution to overall satisfaction.

CONCLUSION

This study gave some suggestions for tertiary hospitals in advanced areas of the People's Republic of China. Outpatient sociodemographic characteristics should be paid more attention by medical staff to improve the degree of satisfaction. Tertiary hospitals in the People's Republic of China should provide more support on the management of doctors, medical costs, and time.

Physician gender, physician patient-centered behavior, and patient satisfaction: a study in three practice settings within a hospital

OBJECTIVE

To compare male and female physicians on patient-centeredness and patients' satisfaction in three practice settings within a hospital; to test whether satisfaction is more strongly predicted by patient-centeredness in male than female physicians.

METHODS

Encounters between physicians (N=71) and patients (N=497) in a hospital were videotaped and patients' satisfaction was measured. Patient-centeredness was measured by trained coders.

RESULTS

In the outpatient setting, female physicians were somewhat more patient-centered than male physicians; patient satisfaction did not differ. In the inpatient and emergency room settings, female physicians were notably more patient-centered than male physicians; satisfaction paralleled these differences. Nevertheless, there was some, though mixed, evidence that patient-centeredness predicted satisfaction more strongly in male than female physicians, suggesting that patients valued patient-centered behavior more in male than female physicians.

CONCLUSION

Even though satisfaction mirrored the different behavior styles of male and female physicians in the inpatient and emergency room settings, in all settings male physicians got somewhat more credit for being patient-centered than female physicians did.

PRACTICE IMPLICATIONS

If female physicians do not consistently receive credit for high patient-centeredness in the eyes of patients, this could lead female physicians to reduce their patient-centered behavior.

A person-centred segmentation study in elderly care: towards efficient demand-driven care

Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on diseases. A person-centred segmentation, i.e., based on persons' own experienced difficulties in fulfilling needs, is an elementary but often overlooked first step in developing efficient demand-driven care. This paper describes a person-centred segmentation study of elderly, a large and increasing target group confronted with heterogeneous and often interrelated difficulties in their functioning. In twenty-five diverse healthcare and welfare organizations as well as elderly associations in the Netherlands, data were collected on the difficulties in biopsychosocial functioning experienced by 2019 older adults. Data were collected between March 2010 and January 2011 and sampling took place based on their (temporarily) living conditions. Factor Mixture Model was conducted to categorize the respondents into segments with relatively similar experienced difficulties concerning their functioning. First, the analyses show that older adults can be empirically categorized into five meaningful segments: feeling vital; difficulties with psychosocial coping; physical and mobility complaints; difficulties experienced in multiple domains; and feeling extremely frail. The categorization seems robust as it was replicated in two population-based samples in the Netherlands. The segmentation's usefulness is discussed and illustrated through an evaluation of the alignment between a segment's unfulfilled biopsychosocial needs and current healthcare utilization. The set of person-centred segmentation variables provides healthcare providers the option to perform a more comprehensive first triage step than only a disease-based one. The outcomes of this first step could guide a focused and, therefore, more efficient second triage step. On a local or regional level, this person-centred segmentation provides input information to policymakers and care providers for the demand-driven allocation of resources.