Are physicians' attitudes of respect accurately perceived by patients and associated with more positive communication behaviors?

被引:154
作者
Beach, Mary Catherine
Roter, Debra L.
Wang, Nae-Yuh
Duggan, Patrick S.
Cooper, Lisa A.
机构
[1] Johns Hopkins Univ, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD 21287 USA
[2] Johns Hopkins Univ, Sch Med, Div Gen Internal Med, Dept Med, Baltimore, MD 21287 USA
[3] Johns Hopkins Univ, Phoebe R Berman Bioeth Inst, Baltimore, MD 21287 USA
关键词
respect; patient-physician communication; attitudes; professionalism;
D O I
10.1016/j.pec.2006.06.004
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Objective: To explore the domain of physician-reported respect for individual patients by investigating the following questions: How variable is physician-reported respect for patients? What patient characteristics are associated with greater physician-reported respect? Do patients accurately perceive levels of physician respect? Are there specific communication behaviors associated with physician-reported respect for patients? Methods: We audiotaped 215 patient-physician encounters with 30 different physicians in primary care. After each encounter, the physician rated the level of respect that s/he had for that patient using the following item: "Compared to other patients, I have a great deal of respect for this patient" on a five-point scale between strongly agree and strongly disagree. Patients completed a post-visit questionnaire that included a parallel respect item: "This doctor has a great deal of respect for me." Audiotapes of the patient visits were analyzed using the Roter Interaction Analysis System (RIAS) to characterize communication behaviors. Outcome variables included four physician communication behaviors: information-giving, rapport-building, global affect, and verbal dominance. A linear mixed effects modeling approach that accounts for clustering of patients within physicians was used to compare varying levels of physician-reported respect for patients with physician communication behaviors and patient perceptions of being respected. Results: : Physician-reported respect varied across patients. Physicians strongly agreed that they had a great deal of respect for 73 patients (34%), agreed for 96 patients (45%) and were either neutral or disagreed for 46 patients (21%). Physicians reported higher levels of respect for older patients and for patients they knew well. The level of respect that physicians reported for individual patients was not significantly associated with that patient's gender, race, education, or health status; was not associated with the physician's gender, race, or number of years in practice;, and was not associated with race concordance between patient and physician. While 45% of patients overestimated physician respect, 38% reported respect precisely as rated by the physician, and 16% underestimated physician respect (r = 0.18, p = 0.007). Those who were the least respected by their physician were the least likely to perceive themselves as being highly respected; only 36% of the least respected patients compared to 59% and 61 % of the highly and moderately respected patients perceived themselves to be highly respected (p = 0.012). Compared with the least-respected patients, physicians were more affectively positive with highly respected patients (p = 0.034) and provided more information to highly and moderately respected patients (p = 0.018). Conclusion: Physicians' ratings of respect vary across patients and are primarily associated with familiarity rather than sociodemographic characteristics. Patients are able to perceive when they are respected by their physicians, although when they are not accurate, they tend to overestimate physician respect. Physicians who are more respectful towards particular patients provide more information and express more positive affect in visits with those patients. Practice implications: Physician respectful attitudes may be important to target in improving communication with patients. (c) 2006 Published by Elsevier Ireland Ltd.
引用
收藏
页码:347 / 354
页数:8
相关论文
共 25 条
[1]  
*AM MED ASS, 2005, DECL PROF RESP MED S
[2]  
[Anonymous], 1995, PROJ PROF
[3]   A SCALE TO MEASURE PHYSICIAN BELIEFS ABOUT PSYCHOSOCIAL-ASPECTS OF PATIENT-CARE [J].
ASHWORTH, CD ;
WILLIAMSON, P ;
MONTANO, D .
SOCIAL SCIENCE & MEDICINE, 1984, 19 (11) :1235-1238
[4]  
Brody H, 1999, J FAM PRACTICE, V48, P585
[5]  
*CMA, 2005, CMA SERIES HLTH CARE
[6]  
*COMM UND EL RAC E, 2002, UN TREATM CONF RAC E
[7]   Further analysis of a doctor-patient nonverbal communication instrument [J].
Gallagher, TJ ;
Hartung, PJ ;
Gerzina, H ;
Gregory, SW ;
Merolla, D .
PATIENT EDUCATION AND COUNSELING, 2005, 57 (03) :262-271
[8]   Medical student attitudes toward the doctor-patient relationship [J].
Haidet, P ;
Dains, JE ;
Paterniti, DA ;
Hechtel, L ;
Chang, T ;
Tseng, E ;
Rogers, JC .
MEDICAL EDUCATION, 2002, 36 (06) :568-574
[9]   Some observations on provider-patient communication research [J].
Hall, JA .
PATIENT EDUCATION AND COUNSELING, 2003, 50 (01) :9-12
[10]   PHYSICIANS LIKING FOR THEIR PATIENTS - MORE EVIDENCE FOR THE ROLE OF AFFECT IN MEDICAL-CARE [J].
HALL, JA ;
EPSTEIN, AM ;
DECIANTIS, ML ;
MCNEIL, BJ .
HEALTH PSYCHOLOGY, 1993, 12 (02) :140-146