Do our talks with patients meet their expectations?

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Original Research

Do our talks with patients meet their expectations?

J Fam Pract. 2007 July;56(7):559-568

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References

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GPs less successful with task-oriented communication aspects. Many patients wanted information, explanations, advice, and help with their problems (85%–94%, TABLE 2). Knowing the diagnosis was less important (77%) than, say, receiving advice on what to do and having details of treatment explained.

GPs also performed most of the task-oriented aspects, if patients considered these aspects important.

Subjectively, preferences for GP task-oriented behavior and perceived performance often went together, though more discrepancies were visible than with affect-oriented behavior. One fifth of patients said their problems were not helped, though they had said this was important. Similarly, GPs did not give a diagnosis to nearly 15% of patients who considered it important.

TABLE 2
Care vs cure-centered communication: Physicians fared better on the care side (N=1787)

AFFECT-ORIENTED ASPECTS (CARE DIMENSION)	PERFORMED		NOT PERFORMED		TOTAL*
AFFECT-ORIENTED ASPECTS (CARE DIMENSION)	N	%	N %	%	N	%
Doctor gave me enough attention
Important	1304	87.5	9	0.6	1313	88.1
Not important	174	11.7	4	0.3	178	11.9
Doctor listened well to me
Important	1456	95.3	10	0.7	1466	95.9
Not important	61	4.0	1	0.1	62	4.1
Doctor took enough time for me
Important	1412	92.3	11	0.7	1423	93.1
Not important	105	6.9	1	0.1	106	6.9
Doctor was friendly
Important	1331	87.2	3	0.2	1334	87.4
Not important	193	12.6	0	0.0	193	12.6
Doctor was frank to me
Important	1451	95.5	5	0.3	1456	95.8
Not important	63	4.15	0	0.0	63	4.2
Doctor took my problem seriously
Important	1455	95.8	7	0.5	1462	96.3
Not important	55	3.6	1	0.1	56	3.7
Doctor was empathic to me
Important	846	58.4	36	2.5	882	60.9
Not important	492	34.0	74	5.1	566	19.1
TASK-ORIENTED ASPECTS (CURE DIMENSION)
Doctor diagnosed what’s wrong
Important	921	62.8	209	14.2	1130	77.0
Not important	197	13.4	140	9.5	337	23.0
Doctor explained well what’s wrong
Important	1166	78.3	101	6.8	1267	85.0
Not important	175	11.7	48	3.2	223	15.0
Doctor informed well on treatment
Important	1304	86.6	109	7.2	1413	93.9
Not important	75	5.0	17	1.1	92	6.1
Doctor gave advice on what to do
Important	1294	85.9	121	8.0	1415	94.0
Not important	75	5.0	16	1.1	91	6.0
Doctor helped me with my problem
Important	1031	70.0	121	18.9	1152	88.9
Not important	94	6.4	16	4.7	110	11.1
Doctor examined me
Important	902	59.9	132	8.8	1034	62.8
Not important	228	15.1	244	16.2	472	27.2
* Totals do not always add up to 1787 because of missing data.

GP communication varies by doctor gender, patient characteristics

GPs engaged less in affect-oriented than in task-oriented communication (48.6 and 70.0 utterances on average, respectively, P≤.001).

The more patients regarded affect-oriented talk by GPs as important, the more the GPs actually showed affective and patient-centered behavior (TABLE 3). Preferences for task-oriented behavior (question-asking, information-giving, and counseling) were mirrored in their doctors’ talk.

When taking into account other GP and patient characteristics, female doctors were more often affect-oriented as well as task-oriented when communicating with patients than were male doctors, especially with female patients. In consultations with older patients and those in poor health, the doctors were more affective than in consultations with younger and healthy patients.

TABLE 3
On observation, physician communication corresponded to patient preferences (N GPs=142, N patients=1787)

	REGRESSION COEFFICIENTS
	AFFECT-ORIENTED TALK GPs	TASK-ORIENTED TALK GPs	PATIENT-CENTEREDNESS
GP characteristics
Age (yrs)	–0.20	–0.37*	–0.01*
Full-time equivalents	–12.13*	2.45	0.03
Patient characteristics
Gender-dyad:
- Male/female	–0.89^c	0.17^d	0.01
- Female/male	9.40^a,b,d	6.24^a,d	0.10
- Female/female	5.73^a,c	6.85^a,b,c	0.02
Age (yrs)	0.09*	–0.15	–0.00*
Education (1=low, 2=middle, 3=high)	–0.70	0.15	0.05
Psychosocial problems (1=yes)	7.93*	–4.62*	0.13*
Overall health (1=excellent, 5=poor)	1.13*	0.96	–0.01
Depressive feelings (1=not at all, 5=extremely)	0.78	–0.72	0.01
Consultation length (min)	4.03*	4.30*	0.04*
Patients’ preferences
Affect-oriented preference (1=not, 4=utmost important)	2.81*	–1.94	0.16*
Task-oriented preference (1=not, 4=utmost important)	–4.23 *	3.62*	–0.15*
* P<.05
a. Score differs significantly from score of male GP/male patient dyad (reference group).
b. Score differs significantly from score of male GP/female patient dyad.
c. Score differs significantly from score of female GP/male patient dyad.
d. Score differs significantly from score of female GP/female patient dyad.

Discussion

Our study suggests most patients receive from their GPs the kind of communication they prefer in a consultation. In general, patients consider both affect- and task-oriented communication aspects important, and believe they are often performed. Our findings agree with most of the literature.^5,14,20 Furthermore, patients’ preferences are for the greater part reflected in the GPs’ observed communication during the visit, which agrees with one earlier study¹⁸ but not with others.^5,20

FAST TRACK

Patients who prefer a caring doctor were more likely to get one who was empathic, concerned, interested, and patient-centered

Patient preference for an affective doctor is very often met. GPs are generally considered attentive, friendly, frank, empathic, and good listeners. Patients seem satisfied in this respect. However, the task-oriented communication of the GPs is sometimes less satisfying. Contrary to patient preference, for example, GPs are not always able to make a diagnosis.

Observed physician behavior: patients usually get what they want. Looking at the relationship between preferences and actual GP communication, it appears that the more patients prefer an affective or caring doctor, the more they are likely to get an empathic, concerned, interested, and patient-centered doctor, especially when psychosocial problems are expressed. An affective GP was patient centered, involving patients in problem definition and decision making. This relationship between affective behavior and patient-centeredness was also found in earlier studies.^22,29 However, Swenson found that not all patients wanted the doctor to exhibit a patient-centered approach.³⁰

FAST TRACK

Patients who preferred a task-oriented doctor were more likely to have one who explained things well

Likewise, the more patients prefer a task-oriented doctor, the better the chance they will have a doctor who explains things well, and who gives information and advice to their satisfaction. However, task-oriented doctors are usually less affective and less patient-centered when talking with patients. In view of the postulate that a doctor has to be curing as well as caring,⁶ doctors would be wise to give attention to both aspects.

GPs do improvise while communicating with patients. The study shows that GPs and patients working together can create the type of encounter both want. GPs are able to change their behavior in response to real-time cues they believe patients are giving in an encounter.