Doctor-Patient Relationship in the Eyes of Medical Professionals in China During the COVID-19 Pandemic: A Cross-Sectional Study

Impact Analysis of COVID-19 Pandemic on Hospital Reviews on Dianping Website in Shanghai, China: Empirical Study

BACKGROUND

In the era of the internet, individuals have increasingly accustomed themselves to gathering necessary information and expressing their opinions on public web-based platforms. The health care sector is no exception, as these comments, to a certain extent, influence people's health care decisions. During the onset of the COVID-19 pandemic, how the medical experience of Chinese patients and their evaluations of hospitals have changed remains to be studied. Therefore, we plan to collect patient medical visit data from the internet to reflect the current status of medical relationships under specific circumstances.

OBJECTIVE

This study aims to explore the differences in patient comments across various stages (during, before, and after) of the COVID-19 pandemic, as well as among different types of hospitals (children's hospitals, maternity hospitals, and tumor hospitals). Additionally, by leveraging ChatGPT (OpenAI), the study categorizes the elements of negative hospital evaluations. An analysis is conducted on the acquired data, and potential solutions that could improve patient satisfaction are proposed. This study is intended to assist hospital managers in providing a better experience for patients who are seeking care amid an emergent public health crisis.

METHODS

Selecting the top 50 comprehensive hospitals nationwide and the top specialized hospitals (children's hospitals, tumor hospitals, and maternity hospitals), we collected patient reviews from these hospitals on the Dianping website. Using ChatGPT, we classified the content of negative reviews. Additionally, we conducted statistical analysis using SPSS (IBM Corp) to examine the scoring and composition of negative evaluations.

RESULTS

A total of 30,317 pieces of effective comment information were collected from January 1, 2018, to August 15, 2023, including 7696 pieces of negative comment information. Manual inspection results indicated that ChatGPT had an accuracy rate of 92.05%. The F1-score was 0.914. The analysis of this data revealed a significant correlation between the comments and ratings received by hospitals during the pandemic. Overall, there was a significant increase in average comment scores during the outbreak (P<.001). Furthermore, there were notable differences in the composition of negative comments among different types of hospitals (P<.001). Children's hospitals received sensitive feedback regarding waiting times and treatment effectiveness, while patients at maternity hospitals showed a greater concern for the attitude of health care providers. Patients at tumor hospitals expressed a desire for timely examinations and treatments, especially during the pandemic period.

CONCLUSIONS

The COVID-19 pandemic had some association with patient comment scores. There were variations in the scores and content of comments among different types of specialized hospitals. Using ChatGPT to analyze patient comment content represents an innovative approach for statistically assessing factors contributing to patient dissatisfaction. The findings of this study could provide valuable insights for hospital administrators to foster more harmonious physician-patient relationships and enhance hospital performance during public health emergencies.

Willingness to maintain contracts with family doctors among Chinese residents: results from one national cross-sectional study and a meta-analysis of 25 studies

Background

A number of studies have investigated the influencing factors regarding the renewal of contracts associated with Family Doctor Contract Services (FDCS) in different regions of China since it was officially implemented in 2009; however, none of the previous studies have been considered using a nationally representative sample in combination with a meta-analysis.

Methods

A multistage stratified sampling method was used to investigate participants' socio-demographic characteristics, health status, understanding, use, and evaluation of the FDCS, and their willingness to renew contracts in Eastern, Central, and Western China from September to November 2021. We searched the PubMed, Ovid Medline, CNKI, VIP, Wanfang, and SinoMed databases to retrieve previous studies related to the willingness of Chinese residents to renew contracts with their family doctor (FD), and a meta-analysis was performed to systematically summarize the willingness to maintain contracts and influencing factors.

Results

Among 2,394 residents, 2,122 (88.64%) were willing to renew their contracts. The mixed-effect logistic regression model results demonstrated that residents who (1) preferred primary health service institutions, (2) had a better knowledge of FDCS, (3) were more willing to visit primary health service after signing the contract with FDs, (4) were not intending to change FDs, (5) were satisfied with FDCS, and (6) trusted in FDs reported a higher level of willingness to maintain contracts with FDs. Our meta-analysis confirmed that older age, being married, having chronic diseases, choosing primary medical institutions for the first contact, having a good knowledge of FDCS/FDs, being satisfied with FDCS and the medical skills of FDs, and trusting FDs were all positively associated with residents' willingness to renew contracts (p < 0.05).

Conclusion

The willingness of consumers to maintain contracts with FDs in China varies in different areas. Giving priority services to groups of high need contributed to an improved rate of renewal. We suggest that in order to continue to increase annual contract renewal, it is necessary to strengthen consumer awareness through effective marketing and continue to work toward meeting consumer expectations, thereby increasing confidence and trust in FDCS.

The relationship between psychological capital, patient's contempt, and professional identity among general practitioners during COVID-19 in Chongqing, China

General practitioners are crucial in the primary healthcare system as well as for epidemic prevention and control. However, few researchers have examined their professional identity. This study investigated the current status of the professional identity of general practitioners in Chongqing, China and explored the effects of psychological capital and patient's contempt on their professional identity. From December 2021 to January 2022, randomized cluster sampling was used to conduct a cross-sectional online self-assessment questionnaire survey among general practitioners in Chongqing. In total, 2,180 general practitioners working for more than one year were selected. General practitioners' sense of professional identity, mental health, and sense of patients' disrespect were measured using the Professional Identity Scale, Psychological Capital Questionnaire, and Patient's Contempt Questionnaire. Sociodemographic characteristics were also collected. A multiple linear regression model was used to analyze the association between professional identity, psychological capital, and patient's contempt. The average score for professional identity among general practitioners was 53.59 (SD = 6.42). The scores for self-efficacy, hope, resilience, and optimism (subscales of psychological capital) were 26.87 (SD = 5.70), 26.47 (SD = 5.74), 26.97 (SD = 5.55), and 26.86 (SD = 5.59), respectively. The score for perceived contempt was 34.19 (SD = 7.59). An average monthly income greater than CNY 8,000 (β = 1.018, p < 0.001), work tenure of more than 15 years (β = 0.440, p = 0.001), hope (β = 0.249, p < 0.001) and a higher optimism score (β = 0.333, p < 0.001) were positively correlated with professional identity. Having a bachelor's degree and above (β = -0.720, p = 0.014), an administrative role (β = -1.456, p < 0.001), self-efficacy (β = -0.122, p < 0.001), and higher patient's contempt (β = -0.103, p < 0.001) were negatively associated with professional identity. General practitioners in Chongqing demonstrated high professional identity and a strong psychological status during the COVID-19 pandemic. Psychological capital and patient's contempt were associated with professional identity. To improve general practitioners' professional identity, stakeholders should promote practitioners' mental health and physician-patient relationships in China.

Enhancing doctor-patient relationships in community health care institutions: the Patient Oriented Four Habits Model (POFHM) trial-a stepped wedge cluster randomized trial protocol

BACKGROUND

The poor relationship between doctors and patients is a long-standing, global problem. However, current interventions tend to focus on the training of physicians, while patient-targeted interventions still need to be improved. Considering that patients play a significant role in outpatient consultations, we developed a protocol to assess the effectiveness of the Patient Oriented Four Habits Model (POFHM) in improving doctor-patient relationships.

METHODS

A cross-sectional incomplete stepped-wedge cluster randomized trial design will be conducted in 8 primary healthcare institutions (PHCs). Following phase I of "usual care" as control measures for each PHC, either a patient- or doctor-only intervention will be implemented in phase II. In phase III, both patients and doctors will be involved in the intervention. This study will be conducted simultaneously in Nanling County and West Lake District. The primary outcomes will be evaluated after patients complete their visit: (1) patient literacy, (2) sense of control and (3) quality of doctor-patient communication. Finally, a mixed-effects model and subgroup analysis will be used to evaluate the effectiveness of the interventions.

DISCUSSION

Fostering good consultation habits for the patient is a potentially effective strategy to improve the quality of doctor-patient communication. This study evaluates the implementation process and develops a rigorous quality control manual using a theoretical domain framework under the collective culture of China. The results of this trial will provide substantial evidence of the effectiveness of patient-oriented interventions. The POFHM can benefit the PHCs and provide a reference for countries and regions where medical resources are scarce and collectivist cultures dominate.

TRIAL REGISTRATION

AsPredicted #107,282 on Sep 18, 2022; https://aspredicted.org/QST_MHW.

Perceived a community with shared future for doctor-patient and benefit finding: a moderated mediation model

BACKGROUND

Under the background that the concept of a community with shared future for mankind has been advocated, the doctor-patient relationship has rapidly sublimated into a community with shared future for doctor-patient. The purpose of this study was to analyze the changes and relationships of anxiety, perceived a community with shared future for doctor-patient (PCSF), health self-consciousness (HSC) and benefit finding (BF) in the outbreak stage of COVID-19 and in the stable stage of COVID-19.

METHODS

The questionnaire consisted of a self-designed health self-consciousness scale, perceived a community with shared future for doctor-patient scale, revised 7-item generalized anxiety disorder scale and benefit finding scale. Questionnaires were administered in the outbreak stage of COVID-19 and in the stable stage of COVID-19 to address public anxiety, BF, and trust between medical staff and patients.

RESULTS

Risk perception will increase anxiety in public, and the public who trust medical staff and the ability of the government to prevent and control the epidemic will have a higher PCSF. Compared with those in the outbreak stage of COVID-19, PCSF, HSC and BF all decreased in the stable stage of COVID-19. HSC partly plays a mediating role in the process of the influence of PCSF and BF (95% CI = [0.3785, 0.5007], [0.2357, 0.3695], P < .001). The R-value of the model in the outbreak stage of COVID-19 and in the stable stage of COVID-19 were 0.555 and 0.429, and the value of R² was 0.308 and 0.184 respectively (P < .001). In the stable stage of COVID-19, the coefficient of anxiety ✕ PCSF is negative. The B values of anxiety and PCSF are positive, and the moderating effect is negative (P = .038). Anxiety has a negative moderating effect between PCSF and HSC, indicating that anxiety will weaken the positive impact of PCSF on HSC. It means that there exists a substitution relationship between anxiety and PCSF.

CONCLUSIONS

The common goal of medical staff and patients is health, and health is the premise of the meaning of life. Vigorously advocating for PCSF can not only promote a harmonious doctor-patient relationship, but also establish a good HSC and improve the understanding of the meaning of life in the public. Furthermore, if the common concept of a community with a shared future for doctor-patient is integrated into the values of life, it may be more stable and long-term to maintain a good doctor-patient relationship. In addition, we should guard against the influence of high-level anxiety on the path of meaning perception.

Insights Into the Relationships Between Health Communication and Doctor-patient Relationship: A Scientometric Analysis Based on CiteSpace and Validation of Questionnaires

In order to understand the research status of the relationship between health communication and doctor-patient relationship, and to explore a new path of the impact of health communication on doctor-patient relationship, this paper adopted qualitative methods to quantize the literature over the past 10 years in the Web of Science database and carried out Co-Authorship Analysis, Co-Citation Analysis and Co-Occurrence Analysis based on CiteSpace. In addition, according to the results of bibliometric research, self-designed questionnaires were used to verify the result. A convenience sampling survey was conducted through the online "Questionnaire Star" platform (https://www.wjx.cn) on May 8, 2022, and a total of 254 questionnaires were collected. Interviewees were asked to use social software to acquire health knowledge. Participants come from 21 provinces, 4 municipalities, and 4 autonomous regions across the country, which is geographically representative. The results show that uncertainty of social media information and the particularity of the epidemic make the research on health communication and doctor-patient relationship in social media become a new hot spot. Social media health information quality (source credibility and content trust perception), information asymmetry perception, doctor-patient communication, doctor-patient consistency, doctor-patient trust, doctor-patient relationship may be the key variables for constructing theoretical models.

Explicating the Cognitive Process of a Physician's Trust in Patients: A Moderated Mediation Model

Trust is considered a critical factor in the physician-patient relationship. However, little is known about the development and impact of physicians trusting their patients. A model that is premised on the integrated model of organizational trust was proposed in this article to reveal the cognitive processes involved in physicians' trust, with perceived integrity and the ability of the patient as antecedents and the physicians' communication efficacy as the outcome. A cross-sectional survey of 348 physicians in Zhejiang province, China, revealed that a physician's trust in a patient mediated the relationship between the physicians' perception of the integrity and ability of the patient, and the physician's communication efficacy. The physicians' educational backgrounds and work experience were also found to moderate an indirect effect: a lower level of education and longer work experience intensified the impact of the perceived integrity and ability of the patient on the physician's trust, while shorter work experience made the association between the physician's trust and communication efficacy more salient. This paper provided implications for both physician and patient sides.

Posttraumatic stress disorder and depression of Chinese medical staff after 2 years of COVID-19: A multicenter study

BACKGROUND

In December 2019, coronavirus disease (COVID-19) was first reported in Wuhan, China, and has had a negative psychological impact on the medical staff. However, the long-term psychological effects of COVID-19 were still unclear. We aimed to assess the posttraumatic stress disorder (PTSD) and depression among medical staff 2 years after COVID-19 pandemic in Wuhan, China.

METHODS

We conducted a multicenter study in five general hospitals in Wuhan, China. PTSD was assessed using the PTSD Checklist-5. Depression was measured by the Center for Epidemiologic Studies Depression Scale. Multivariate adjusted logistic regression models were used to evaluate the association among demographic variables, depressive indicators, and PTSD.

RESULTS

In a sample of 1795 medical staff, 295 (16.40%) participants reported PTSD and 329 (18.30%) reported depression. After multivariate adjusted logistic regression analyses, participants involved in COVID-19 clinical work, unsafe working environment, poor doctor-patient relationship, unhealth status, work dissatisfaction, and low family support were at a high risk for PTSD and depression 2 years after the outbreak of COVID-19 pandemic.

CONCLUSIONS

Although it has been more than 2 years after the COVID-19 pandemic outbreak, the mental health of medical staff remains a concern. In particular, medical staff involved in the clinical care of COVID-19 patients showed a higher risk of PTSD and depression 2 years after the COVID-19 pandemic. This study may provide some useful suggestions for psychological interventions for medical staff.

Current Status of Intergroup Threats Perceived by Chinese Physicians and Its Association with Organizational Psychology, Behavior, and Well-Being during the COVID-19 Pandemic: A Cross-Sectional Survey

(1) Background: Chinese physicians have encountered serious physical and verbal attacks in recent decades due to poor patient−physician relationships, leading to a broad spectrum of negative consequences. This study aims to assess the status of intergroup threats perceived by physicians and explore its association with organizational psychology, behavior, and well-being during the COVID-19 pandemic. (2) Methods: We conducted a cross-sectional online survey with physicians from November to December 2020 in three provinces: Heilongjiang Province, Henan Province, and Zhejiang Province, in China. A total of 604 physicians were recruited to complete an anonymous questionnaire. There were 423 valid questionnaires. (3) Results: We developed a 25-item intergroup threat scale with four dimensions: interest damage, performance impairment, value derogation, and unjust sentiment. Internal consistency reliability analyses showed that the four dimensions and overall scale exhibited high internal consistency (0.756−0.947). Additionally, the average scores for physicians’ perceived overall intergroup threat, interest damage, performance impairment, value derogation, and unjust sentiment were 4.35 ± 0.51, 4.24 ± 0.73, 4.33 ± 0.58, 4.22 ± 0.65, and 4.53 ± 0.55, respectively. Moreover, this study shows that the intergroup threats perceived positively by physicians were associated with psychological stress (β = 0.270, p < 0.01), emotional exhaustion (β = 0.351, p < 0.01), turnover intention (β = 0.268, p < 0.01), and defensive medical behavior (β = 0.224, p < 0.01), and were negatively associated with job satisfaction (β = −0.194, p < 0.01) and subjective well-being (β = −0.245, p < 0.01). (4) Conclusions: The newly developed scale in this study is a reliable tool for measuring intergroup threats perceived by Chinese physicians. Physicians in China were suffering high-level intergroup threats during the anti-COVID-19 pandemic, which has a significant impact on damage to organizational psychology, behavior, and well-being. Intergroup threats perceived by physicians not only enlarged the risk of emotional exhaustion and psychological stress but also threatened organizational well-being. Moreover, greater intergroup threats were associated with a lower job satisfaction, more frequent defensive medical behavior, and a higher turnover intention for physicians. The results of this study suggest that essential intervention and governance measures should be considered to protect physicians’ well-being and benefits in China, which are urgently needed.

The impact of COVID-19 on the doctor-patient relationship in China

A strong doctor-patient relationship (DPR) is crucial to the effectiveness of treatment. It is imperative to maintain a good DPR during treatment. During 2019, Coronavirus Disease 2019 (COVID-19) brought new challenges to already difficult doctor-patient relationships. This paper summarized the current state of the DPR, compared the changes between China and other countries after the outbreak of COVID-19, and listed the solutions proposed by various countries. Finally, the author suggested some solutions in order to improve the DPR according to China's own circumstances.