|Doctor gave me enough attention|
|Doctor listened well to me|
|Doctor took enough time for me|
|Doctor was friendly|
|Doctor was frank to me|
|Doctor took my problem seriously|
|Doctor was empathic to me|
|TASK-ORIENTED ASPECTS (CURE DIMENSION)|
|Doctor diagnosed what’s wrong|
|Doctor explained well what’s wrong|
|Doctor informed well on treatment|
|Doctor gave advice on what to do|
|Doctor helped me with my problem|
|Doctor examined me|
|* Totals do not always add up to 1787 because of missing data.|
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.
|AFFECT-ORIENTED TALK GPs||TASK-ORIENTED TALK GPs||PATIENT-CENTEREDNESS|
|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*|
|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*|
|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.|
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
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
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.
Physician gender often makes a difference. Our findings suggest that female doctors are more affective and task-oriented when talking with their patients than are male doctors, especially with female patients. In view of the steady increase of female doctors in general practice, this combined communication style may become more common in the future.
Psychosocial complaints prompt affective communication. Patients with a psychosocial problem are more likely to encounter an affective doctor than those with a biomedical problem. The growing number of psychosocial problems in the population may lead to a more affective communication.
Eventually the demand and the supply of affective communication may coincide. However, it is a challenge for every doctor to keep his or her mind open to both biomedical (task-oriented) and psychosocial (affective-oriented) information.31
Study caveats. Because we used scale scores for affect- and task-oriented preferences instead of the separate item scores for patient preferences, the reflection of preferences for GP communicative behavior might be somewhat overestimated. Likewise, we used total observation scores for affect- and task-oriented talk instead of the separate RIAS categories. More detailed measures of such communication aspects as empathy might give better insight into patient preferences.
Final thoughts on personal application. Primary care physicians would do well to take notice of patients’ preferences for communication. GPs in our study were often able to grasp what patients considered important to talk about, and there seemed to be only modest mismatches between patient expectations and physician behavior. To increase the quality of health care, consider asking patients at the end of a visit whether their preferences were met.
· Acknowledgments ·
We acknowledge the participating general practitioners and patients, the observers of the videotaped consultations, and the Ministry of Health, Welfare and Sports for funding (for the greater part) the research project.
No potential conflict of interest relevant to this article was reported.
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Correspondence: A. van den Brink-Muinen, PhD, NIVEL, PO Box 1568, 3500 BN Utrecht, The Netherlands; firstname.lastname@example.org
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