Doctor and patient perceptions of the level of doctor explanation and quality of patient-doctor communication

Personalized Communication with Patients at the Emergency Department—An Experimental Design Study

Communication of clinicians at the emergency department is a barrier to patient satisfaction due to lack of human connection, lack of control over the situation, low health literacy, deficient information, poor support at a time of uncertainty all affecting perceived quality of care. This explorative study tests drivers of patient satisfaction with communication of clinicians at the emergency department. The sample comprises 112 Americans from the New York greater area, who visited an emergency department in the past year. A conjoint-based experimental design was performed testing six messages in six categories. The categories encompass acknowledged aspects of communication with health providers enabling to compare among them when exploring communication at the ED by patient preferences. Respondents rated messages by the extent to which it drives their satisfaction with communication of clinicians at the emergency department. Based on the similarity of patients’ response patterns to each message, three significantly distinct mindsets of patient preferences regarding communication exchanges with clinicians at the emergency department emerged. Different conduct and communication messages drive the satisfaction of members of each mindset with the communication of clinicians at the emergency department. The strong performing messages for one mindset are irrelevant for members of other mindsets. Clinicians may identify the patient-belonging to a mindset and communicate using mindset-tailored messages. This novel strategy may enable clinicians to implement patient-centered communication, by mindset, promoting patient satisfaction and enabling clinicians to better cope with patients in the chaotic emergency department environment.

Assessment of patients' understanding of inflammatory bowel diseases: Development and validation of a questionnaire

Background

Educating patients regarding thier inflammatory bowel disease (IBD) is important for their empowerment and disease management. We aimed to develop a questionnaire to evaluate patient understanding and knowledge of IBD.

Methods

We have developed the Understanding IBD Questionnaires (U‐IBDQ), consisting of multiple‐choice questions in two versions [for Crohn's disease (CD) and ulcerative colitis (UC)]. The questionnaires were tested for content and face validity, readability, responsiveness and reliability. Convergent validity was assessed by correlating the U‐IBDQ score with physician's subjective assessment scores. Discriminant validity was assessed by comparison to healthy controls (HC), patients with chronic gastrointestinal (GI) conditions other than IBD, and to GI nurses. Multivariate analysis was performed to determine factors associated with a high level of disease understanding.

Results

The study population consisted of IBD patients (n = 106), HC (n = 35), chronic GI disease patients (n = 38) and GI nurses (n = 19). Mean U‐IBDQ score among IBD patients was 56.5 ± 21.9, similar for CD and UC patients (P = 0.941), but significantly higher than that of HC and chronic GI disease patients and lower than that of GI nurses (P < 0.001), supporting its discriminant validity. The U‐IBDQ score correlated with physician's subjective score (r = 0.747, P < 0.001) and was found to be reliable (intra‐class correlation coefficient = 0.867 P < 0.001). Independent factors associated with high U‐IBDQ scores included academic education (OR = 1.21, 95% CI 1.10–1.33, P < 0.001), biologic therapy experience (OR = 1.24, 95% CI 1.01–1.53, P = 0.046), and IBD diagnosis at <21 years of age (OR = 2.97, 95% CI 1.05–8.87, P = 0.050).

Conclusions

The U‐IBDQ is a validated, reliable and short, self‐reported questionnaire that can be used for assessing understanding of disease pathophysiology and treatment by IBD patients.

Established knowledge on this subject

Inflammatory bowel diseases (IBD) patients' beliefs and knowledge regarding their disease may affect disease management, quality of life and disease‐related psychological health. Therapy‐related disinformation is associated with low adherence to treatment.

A standardized and validated tool for assessment of IBD patients' knowledge and understanding of their disease is lacking.

Significant findings of this study

We developed and meticulously validated the understanding of IBD questionnaire, a short questionnaire aimed at measuring understanding of disease pathophysiology and treatment of IBD.

Inflammatory bowel diseases‐related knowledge was associated with education level and with younger age at IBD diagnosis.

Egyptian patients'/guardians' experiences and perception about clinical informed consent and its purpose: Cross sectional study

BACKGROUND

Informed consent (IC) is a healthcare standard emphasizing the meaning of human dignity as clarified in the Universal Declaration of Human Rights. Data about IC practices in Egypt is insufficient. This study aimed to assess the Egyptian patients'/guardians' experiences about IC and their expectations about its practices' purposes in general and according to the type of the healthcare facility.

METHODS

Self-administered questionnaire was carried out for 1092 participants who had undergone or were scheduled to a procedure requiring an IC at three studied types for Egyptian health care facilities. Ten statements were ranked twice by the participants to reflect their perception of IC purpose as per what is currently practiced and what they believe should be practiced.

RESULTS

IC implementation varies significantly (p<0.05) across the health care facilities in Egypt. The percentage of its implementation at the non-governmental facilities, governmental facilities, and university hospital was 85.9%, 77.8%, and 63.8 respectively. The first three ranked purposes of the current IC practices were: "Helping patient/guardian decide (64.9%)", "Documenting patient's/guardian's decision (59.3%)", and "Having shared decision (57.3%)". The perceived purposes of IC to be practiced were: "Informing the patient/guardian (68.4%)", "Making sure patient/guardian understand (65.3%)" and "Documenting patients/guardians decisions (65.1%)". "Being a meaningless routine" was reported by the majority to be ranked as a low purpose for IC current and preferred practices.

CONCLUSION

The practice of IC is common within the Egyptian medical community. Participants believe that information disclosure "Making sure patients understand" has to help in IC decision making and its main purpose. However, unfortunately, this is not perceived as a current purpose of IC. There was consensus agreement that documenting the patient's/guardian's decision and informing the patient/guardian are perceived as both important current and preferred purposes for IC practices.

Egyptian patients’/guardians’ experiences and perception about clinical informed consent and its purpose: Cross sectional study

Background

Informed consent (IC) is a healthcare standard emphasizing the meaning of human dignity as clarified in the Universal Declaration of Human Rights. Data about IC practices in Egypt is insufficient. This study aimed to assess the Egyptian patients’/guardians’ experiences about IC and their expectations about its practices’ purposes in general and according to the type of the healthcare facility.

Methods

Self-administered questionnaire was carried out for 1092 participants who had undergone or were scheduled to a procedure requiring an IC at three studied types for Egyptian health care facilities. Ten statements were ranked twice by the participants to reflect their perception of IC purpose as per what is currently practiced and what they believe should be practiced.

Results

IC implementation varies significantly (p<0.05) across the health care facilities in Egypt. The percentage of its implementation at the non-governmental facilities, governmental facilities, and university hospital was 85.9%, 77.8%, and 63.8 respectively. The first three ranked purposes of the current IC practices were: “Helping patient/guardian decide (64.9%)”, “Documenting patient’s/guardian’s decision (59.3%)”, and “Having shared decision (57.3%)”. The perceived purposes of IC to be practiced were: “Informing the patient/guardian (68.4%)”, “Making sure patient/guardian understand (65.3%)” and “Documenting patients/guardians decisions (65.1%)”. “Being a meaningless routine” was reported by the majority to be ranked as a low purpose for IC current and preferred practices.

Conclusion

The practice of IC is common within the Egyptian medical community. Participants believe that information disclosure “Making sure patients understand” has to help in IC decision making and its main purpose. However, unfortunately, this is not perceived as a current purpose of IC. There was consensus agreement that documenting the patient’s/guardian’s decision and informing the patient/guardian are perceived as both important current and preferred purposes for IC practices.

"A Bridge Over Troubled Water": Nurses' Leadership in Establishing Young Adults' Trust Upon the Transition to Adult Renal-Care - A Dual-Perspective Qualitative Study

PURPOSE

Patient trust is strongly related to adherence, but has not been tested in transitional care. Low adherence post-transitions of young adults from pediatrics to adult renal care jeopardizes transplanted kidneys and quality of life. We aimed at identifying barriers to trust of young adults in nurses and trust-building elements upon and post transition.

DESIGN AND METHODS

Following IRB approval, we recruited 21 young adults who underwent kidney transplants before the transition to adult renal care and eleven nurses from adult care in two Israeli tertiary hospitals that perform kidney transplants. We conducted 42 in-depth narrative interviews with young adults and one interview with each nurse. We used thematic analysis guided by Meleis's framework of effective transitions.

RESULTS

Most young adults' attributed negative meanings to the transition to adult care which did not enhance their well-being. Young adults were not provided with resources to promote their autonomy and role-sufficiency; despite preparation processes pre-transition, they were not aware of expectations from them. Their own unmet expectations of clinicians made them feel unsafe, objectified, and helpless and resulted in distrust in professionals, low adherence, and in some cases, dropping out of care and lower quality of life.

CONCLUSIONS

Nurses who focused on building a relationship with young adults rather than on operational tasks established trust and led young adults towards role-sufficiency, satisfaction with care, adherence, and optimized quality of life.

PRACTICE IMPLICATIONS

The proposed recommendations for nurses and clinicians structure the trust-building process using elements to improve transitional care.

Infringement of the right to surgical informed consent: negligent disclosure and its impact on patient trust in surgeons at public general hospitals - the voice of the patient

BACKGROUND

There is little dispute that the ideal moral standard for surgical informed consent calls for surgeons to carry out a disclosure dialogue with patients before they sign the informed consent form. This narrative study is the first to link patient experiences regarding the disclosure dialogue with patient-surgeon trust, central to effective recuperation and higher adherence.

METHODS

Informants were 12 Israelis (6 men and 6 women), aged 29-81, who underwent life-saving surgeries. A snowball sampling was used to locate participants in their initial recovery process upon discharge.

RESULTS

Our empirical evidence indicates an infringement of patients' right to receive an adequate disclosure dialogue that respects their autonomy. More than half of the participants signed the informed consent form with no disclosure dialogue, and thus felt anxious, deceived and lost their trust in surgeons. Surgeons nullified the meaning of informed consent rather than promoted participants' moral agency and dignity.

DISCUSSION

Similarity among jarring experiences of participants led us to contend that the conduct of nullifying surgical informed consent does not stem solely from constraints of time and resources, but may reflect an underlying paradox preserving this conduct and leading to objectification of patients and persisting in paternalism. We propose a multi-phase data-driven model for informed consent that attends to patients needs and facilitates patient trust in surgeons.

CONCLUSIONS

Patient experiences attest to the infringement of a patient's right to respect for autonomy. In order to meet the prima facie right of respect for autonomy, moral agency and dignity, physicians ought to respect patient's needs. It is now time to renew efforts to avoid negligent disclosure and implement a patient-centered model of informed consent.

Association Between Dentist-Dental Hygienist Communication and Dental Treatment Outcomes

Communication between physician and patient is critical in all fields of medicine, and various types of communication exist in healthcare settings. Cooperation among healthcare professionals is thought to be essential in providing high-quality services. Dental hygienists are key team members in the provision of dental care, and are known to play an important role in the health of their patients. This study aimed to determine the effect of communication between dentists and hygienists on patient satisfaction. Study subjects were dentists, patients, and dental hygienists, and we examined how dentist-dental hygienist communication affected patient outcome indices. A significant difference was observed only for satisfaction in terms of meeting expectations (p = 0.035). Results for patient satisfaction indicated significant differences in explanatory behavior in dentist-dental hygienist evaluations (p = 0.001). The results showed improved health and reduced fear, indicating significant differences for the dentist-dental hygienist evaluations in explanation behavior (p = 0.016). Our evaluation of the effects of dentist-dental hygienist communication on patient outcomes indicated a significant correlation, suggesting that inter-professional communication in the field of dentistry affects patient satisfaction.

Validation of the generic medical interview satisfaction scale: the G-MISS questionnaire

Background

Patients have about seven medical consultations a year. Despite the importance of medical interviews in the healthcare process, there is no generic instrument to assess patients’ experiences in general practices, medical specialties, and surgical specialties. The main objective was to validate a questionnaire assessing patients’ experiences with medical consultations in various practices.

Method

The G-MISS study was a prospective multi-center trial that enrolled patients from May to July 2016. A total of 2055 patients were included from general practices, medical specialties, and surgical specialties. Patients filled out a questionnaire assessing various aspects of their experience and satisfaction within 1 week after their medical interview. The validation process relied on item response theory. Internal validity was examined using exploratory factorial analysis. The statistical model used the root mean square error of approximation, confirmatory fit index, and standard root mean square residual as fit indices. Scalability and reliability were assessed with the Rasch model and Cronbach’s alpha coefficients, respectively. Scale properties across the three subgroups were explored with differential item functioning.

Results

The G-MISS final questionnaire contained 16 items, structured in three dimensions of patients’ experiences: “Relief”, “Communication”, and “Compliance”. A global index of patients’ experiences was computed as the mean of the dimension scores. All fit indices from the statistical model were satisfactory (RMSEA = 0.03, CFI = 0.98, SRMR = 0.06). The overall scalability had a good fit to the Rasch model. Each dimension was reliable, with Cronbach’s alpha ranging from 0.73 to 0.86. Differential item functioning across the three consultation settings was negligible. Patients undergoing medical or surgical specialties reported higher scores in the “Relief” dimension compared with general practice (83.0 ± 11.6 or 82.4 ± 11.6 vs. 73.2 ± 16.7; P < .001). A consultation shorter than 5 min correlated with low patient satisfaction in “Relief” and “Communication” and in the global index, P < .001.

Conclusions

The G-MISS questionnaire is a valid and reliable questionnaire for assessing patients’ experiences after consultations with general practitioners, medical specialists, and surgical specialists. The multidimensional structure relies on item response theory and assesses different aspects of patients’ experiences that could be useful in clinical practice and research settings.

Improving doctor-patient communication: content validity examination of a novel urinary system-simulating physical model

Effective doctor-patient communication is essential for establishing a successful doctor-patient relationship and implementing high-quality health care. In this study, a novel urinary system-simulating physical model was designed and fabricated, and its content validity for improving doctor-patient communication was examined by conducting a randomized controlled trial in which this system was compared with photographs. A total of 240 inpatients were randomly selected and assigned to six doctors for treatment. After primary diagnosis and treatment had been determined, these patients were randomly divided into the experimental group and the control group. Patients in the experimental group participated in model-based doctor-patient communication, whereas control group patients received picture-based communication. Within 30 min after this communication, a Demographic Information Survey Scale and a Medical Interview Satisfaction Scale (MISS) were distributed to investigate patients' demographic characteristics and their assessments of total satisfaction, distress relief, communication comfort, rapport, and compliance intent. The study results demonstrated that the individual groups were comparable with respect to demographic variables but that relative to patients in the picture-based communication group, patients in the model-based communication group had significantly higher total satisfaction scores and higher ratings for distress relief, communication comfort, rapport, and compliance intent. These results indicate that the physical model is more effective than the pictures at improving doctor-patient communication and patient outcomes. The application of the physical model in doctor-patient communication is helpful and valuable and therefore merits widespread clinical popularization.

Informed consent in robotic surgery: quality of information and patient perception

Introduction

Obtaining a valid informed consent in the medical and surgical field is a long debated issue in the literature. In robotic surgery we believe in the necessity to follow three arrangements to make the informed consent more complete.

Material and methods

This study presents correlations and descriptions based on forensic medicine concepts research, literature review, and the proposal of an integration in the classic concept of informed consent.

Conclusion

In robotic surgery we believe in the necessity to follow three arrangements to make the IC more complete. Integrate the information already present in the informed consent with data on the surgeon’s experience in RS, the number of procedures of the department and the regional map of expertises by procedure.

[Pedagogic focus-group in pediatrics]

AIM

To assess a new behavioral teaching technique called "focus group pedagogy" (FGP), which consists in a three-step meeting between sick children's parents and medical students (first with students alone, then with parents and students together, then with students alone).

METHODS

This qualitative research ran two sessions (each totaling four to six parents and six students) in which parents were questioned on four main themes: their knowledge of the medical hierarchy, their ability to identify the people in the hospital, their communication with medical staff, and the overall care delivered to their children. A thematic analysis of the verbatim transcript was performed.

RESULTS

In the FGP sessions, medical students voiced opinions on their degree of insertion in the medical and paramedical staff, and reported their presence as ambiguous, between care and learning. Parents voiced their experience of their child's hospital stay but also their wider conception of the parent/patient-physician relationship based on their parent-of-patient/parent-as-patient experiences. The meeting of parents and students highlighted divergent narratives on relationships with caregivers, communication, attitudes, knowledge, and competencies. This approach made it possible to hear and learn the point of view "from the other side," which proved beneficial for students, session leaders, and the care unit organization alike.

CONCLUSION

FGP is a novel and easy way to discover diverse narratives and the technique is feasible and beneficial in pediatric settings.

Patient preferences in selecting a dentist: survey results from the urban population of Riyadh, Saudi Arabia

INTRODUCTION

Awareness of gender- or nationality-driven preconceptions can help dentists to have a better interpretation of the dentist-patient relationship. It is even more noteworthy to understand these predilections in Saudi society, where women and men are usually segregated due to religion- and culture-based considerations. This study is one of the first to explore the preferences of patients when selecting a dentist with respect to gender and nationality in the city of Riyadh, Saudi Arabia.

MATERIALS AND METHODS

A total of 445 community residents residing in Riyadh were randomly selected for a cross-sectional study. The participants completed a survey designed to assess which of two factors (gender and/or nationality) were perceived as most relevant in choosing a dentist. Statistical analysis of the data was performed using the SPSS 11.5 software.

RESULTS

Female participants did not show any preference for the gender of the dentist, whereas 40% of the male participants preferred a male dentist. Participants also favored male dentists in the felds of oral surgery (78.9%), implants (74.1%), endodontics (67.5%), orthodontics (65.8%) and prosthodontics (64.2%). An exception was noted in pediatric dentistry, for which female dentists were favored by 52.8% of the participants. Additionally, most (66.1%) participants did not have any preference for the nationality of the dentist.

CONCLUSION

Riyadh residents showed a general preference for a male dentist but demonstrated no preference for nationality when selecting a dentist.

Communication Strategies and Accommodations Utilized by Health Care Providers With Hearing Loss: A Pilot Study

Purpose

Poor communication between health care providers and patients may negatively impact patient outcomes, and enhancing communication is one way to improve outcomes. Effective communication is particularly important for health care providers who have hearing loss. The authors found that a systematic survey of the communication strategies and experiences of health care providers with hearing loss had not yet been conducted.

Method

In this pilot study, 32 health care professionals with hearing loss were recruited via the Association of Medical Professionals With Hearing Losses and were asked to complete a 28-question survey.

Results

Health care providers with hearing loss already employ strategies that all health care providers are encouraged to use in order to enhance patient–provider communication, and survey participants have found the strategies to be effective.

Conclusions

The communication techniques and assistive technologies used by individuals with hearing loss seem to be effective: All participants reported feeling able to communicate effectively with patients at least most of the time. More research is needed to determine if use of these communication techniques has similar results for health care providers without hearing loss.

Development of a quality of patient-health care provider communication scale from the perspective of patients with rheumatoid arthritis

OBJECTIVES

To devise a patient-perspective driven measure of the quality of patient-health care provider communication and to evaluate the psychometric properties of this scale in a sample of 150 patients with rheumatoid arthritis.

METHODS

Items were developed from interviews with 15 patients with rheumatoid arthritis. Two rheumatologists, a behavioral scientist, and a nurse researcher provided item feedback. Exploratory factor analysis with Oblimin rotation was used to examine the dimensionality of the newly developed Patient-Health Care Provider Communication Scale (PHCPCS). Cronbach's alpha was computed to assess internal consistency. Test-retest reliability was determined using the intraclass correlation coefficient. Construct validity was tested by comparing the PHCPCS with the Perceived Involvement in Care Scale (PICS) using correlation analysis.

RESULTS

The PHCPCS measured two dimensions of the quality of patient-health care provider communication [Quality Communication (α = 0.94) and Negative Patient-Health Care Provider Communication (α = 0.73)]. The total PHCPCS score and its Quality Communication Subscale were positively correlated with the total score on the PICS and with the doctor facilitation subscale of the PICS.

DISCUSSION

This new measure of the quality of patient-health care provider communication has the potential for use in clinical practice, provider education, and further studies to improve health care to patients with rheumatoid arthritis.

Patient's perception of quality patient--provider communication

PURPOSE

To develop a model of patients' perception of quality patient-healthcare provider communication.

METHODS/SAMPLE

Fifteen patients with rheumatoid arthritis participated in in-depth, audiorecorded interviews. Following transcription verification, interviews were analyzed using constant comparative analysis to identify primary themes and develop a model of patients' perception of quality patient-healthcare provider communication.

FINDINGS

The participants described a multifaceted, dynamic process of quality patient-healthcare provider communication involving the interrelationship between appropriate time and 4 key communication exchanges: patient honesty when explaining symptoms, patients asking questions and offering opinions, healthcare providers asking questions and offering opinions, and healthcare providers disseminating information.

CONCLUSION

By understanding patient-healthcare provider communication from the patient perspective within the rubric of this model, healthcare providers can adapt interactions with patients with rheumatoid arthritis to incorporate dimensions of the exchange that their patients feel create effective communication.

Does questionnaire-based patient feedback reflect the important qualities of clinical consultations? Context, benefits and risks

OBJECTIVE

To explore perceptions of clinical consultations and how they relate to questionnaire-based patient feedback.

METHODS

Telephone interviews with 35 junior doctors and 40 general practice patients who had used the Doctors' Interpersonal Skills Questionnaire (DISQ).

RESULTS

Doctors and patients had similar views of 'good consultations' as relying on doctors' listening and explaining skills. Preferences for a consultation style focused on an outcome or on the doctor-patient relationship may be independent of informational and/or affective consultation content. Respondents felt the important consultation elements were similar in different contexts, and so DISQ feedback would be useful in different settings. Benefits of feedback were identified in the form of patient empowerment and doctors' learning. Risks were identified in the inappropriate use of feedback, both inadvertent and deliberate.

CONCLUSION

The style and content of consultations may be considered as separate dimensions, an approach that may help doctors adapt their communication appropriately to different consultations. Patient feedback focused on communication skills is appropriate, but there are potential risks.

PRACTICE IMPLICATIONS

Doctors should consider the transactional or relational preference of a patient in approaching a consultation. Patient feedback can deliver benefits to doctors and patients, but risks must be acknowledged and mitigated against.

Clinical relationship and psychological experience of hospitalization in "high-risk" pregnancy

OBJECTIVE

To explore, in a systemic view, the reciprocal perceived relationship between hospitalized "high-risk" pregnant women with uncertain fetal prognosis and the multidisciplinary prenatal care team, by the use of specifically developed questionnaires.

STUDY DESIGN

A pilot study in a high-risk pregnancy department. We enrolled 52 pregnant hospitalized women and 17 clinical operators and we interviewed them by the use of open-ended and close-ended question questionnaires.

RESULTS

We described patients' perception of doctors and staff communication, patients' feelings and emotions relating to "high-risk" pregnancy and hospitalization, operators' emotions, perceived facilitating factors, difficulties and resources. In a "high-risk" pregnancy condition, some difficulties in the relationship between hospitalized women and health operators occur. For inpatients the emotional difficulties were mostly connected to the pathologic situation and the contingent loneliness. Although the majority of women said that they understood staff communication and that they established a basic trust towards the entire clinical staff, there was a request for greater outspokenness. For clinical operators the relational and communication difficulties specifically concerned the overall management of the relationship with the patients studied. In particular, they perceived themselves to be called to a greater clearness and clinical reliability.

CONCLUSIONS

Overcoming the dyadic model of the doctor-patient relationship (in a systemic view) by incorporating clinical operators' and inpatients' points of view, seems a useful tool to highlight critical and facilitating factors about the relationship and communication in "high-risk" conditions. Condensation Overcoming the dyadic vision of the doctor-patient relationship, by crossing clinical operator's and inpatient's points of view, seems a useful tool to highlight critical and facilitating factors about the relationship and communication in "high-risk" pregnancy conditions.

Patient and physician perceptions of the physician's explanation and patient responses to physicians

Although theories on meta-cognition and self-monitoring imply the importance of meta-cognition in patient-physician interactions, there is no evidence to support this hypothesis. Thus, we evaluated patient and physician perceptions of the level of a physician's explanation and explored the possible influence of patient meta-cognition on patient responses to physicians. We conducted a questionnaire survey of 579 internist-patient pairs in Japan. The findings show that patient meta-cognition, and not perception, of the sufficiency of a physician's explanation plays a critical role in determining extreme patient responses to a physician, such as ignoring the physician's advice and doctor-shopping, whereas patient perception is a predictor of milder patient responses such as patient understanding and satisfaction.

Acupuncture practitioner-patient communication in Japan

We evaluated acupuncture practitioner–patient communication using pairs of practitioners and patients. Our primary objective was to evaluate the concordance of practitioner and patient perceptions in terms of explanations regarding consultation, therapy, and patient satisfaction. The subjects were 250 practitioners and their 1250 patients in Fukuoka, Japan. Answers were obtained from 91 acupuncture practitioners (36.40%) and 407 patients (32.56%). Of these, responses from 125 pairs without missing values were used for the analysis. When practitioner–patient communication, as evaluated by the difference between the patients’ and the practitioners’ perceptions with respect to the level of practitioner explanation, was good, patient outcome (ie, satisfaction with therapy, improvement in health) was also good. Factors related to poor practitioner–patient communication included age of the practitioner, the number of practitioners at a clinic, the experience of the practitioner, and the age of the patient. These findings may be useful in improving practitioner–patient communication.