How Well Do Doctors Know their Patients? Factors Affecting Physician Understanding of Patients’ Health Beliefs
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An important feature of patient-centered care is physician understanding of their patients’ health beliefs and values.
Determine physicians’ awareness of patients’ health beliefs as well as communication, relationship, and demographic factors associated with better physician understanding of patients’ illness perspectives.
Cross-sectional, observational study.
A convenience sample of 207 patients and 29 primary care physicians from 10 outpatient clinics.
APPROACH AND MEASURES
After their consultation, patients and physicians independently completed the CONNECT instrument, a measure that assesses beliefs about the degree to which the patient’s condition has a biological cause, is the patient’s fault, is one the patient can control, has meaning for the patient, can be treated with natural remedies, and patient preferences for a partnership with the physician. Physicians completed the measure again on how they thought the patient responded. Active patient participation (frequency of questions, concerns, acts of assertiveness) was coded from audio-recordings of the consultations. Physicians’ answers for how they thought the patient responded to the health belief measure were compared to their patients’ actual responses. Degree of physician understanding of patients’ health beliefs was computed as the absolute difference between patients’ health beliefs and physicians’ perception of patients’ health beliefs.
Physicians’ perceptions of their patients’ health beliefs differed significantly (P < 0.001) from patients’ actual beliefs. Physicians also thought patients’ beliefs were more aligned with their own. Physicians had a better understanding of the degree to which patients believed their health conditions had personal meaning (p = 0.001), would benefit from natural remedies (p = 0.049), were conditions the patient could control (p = 0.001), and wanted a partnership with the doctor (p = 0.014) when patients more often asked questions, expressed concerns, and stated their opinions. Physicians were poorer judges of patients’ beliefs when patients were African-American (desire for partnership) (p = 0.013), Hispanic (meaning) (p = 0.075), or of a different race (sense of control) (p = 0.024).
Physicians were not good judges of patient’s health beliefs, but had a substantially better understanding when patients more actively participated in the consultation. Strategies for increasing physicians’ awareness of patients’ health beliefs include preconsultation assessment of patients’ beliefs, implementing culturally appropriate patient activation programs, and greater use of partnership-building to encourage active patient participation.
- Epstein RM, Street RL Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. NIH Publication No. 07–6225.. Bethesda: National Cancer Institute; 2007.
- Epstein RM, Peters E. Beyond information: exploring patients' preferences. JAMA. 2009;302:195–7. CrossRef
- Fishbein M, Cappella JN. The role of theory in developing effective health communications. Journal of Communication. 2006;56:S1–17. CrossRef
- Godin G, Kok G. The theory of planned behavior: a review of its applications to health-related behaviors. Am J Health Promot. 1996;11:87–98.
- Janz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984;11:1–47.
- Collins DL, Street RL Jr. A dialogic model of conversations about risk: Coordinating perceptions and achieving quality decisions in cancer care. Soc Sci Med. 2009;68:1506–12. CrossRef
- Elwyn G, Edwards A, Kinnersley P, Grol R. Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices. Br J Gen Pract. 2000;50:892–9.
- Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002;159:1563–9. CrossRef
- Mercer SW, McConnachie A, Maxwell M, Heaney D, Watt GC. Relevance and practical use of the Consultation and Relational Empathy (CARE) Measure in general practice. Fam Pract. 2005;22:328–34. CrossRef
- Epstein RM, Hadee T, Carroll J, Meldrum SC, Lardner J, Shields CG. "Could this be something serious?" Reassurance, uncertainty, and empathy in response to patients' expressions of worry. J Gen Intern Med. 2007;22:1731–9. CrossRef
- Zachariae R, Pedersen CG, Jensen AB, Ehrnrooth E, Rossen PB, von der Maase H. Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. Br J Cancer. 2003;88:658–65. CrossRef
- Street RL Jr, Richardson MN, Cox V, Suarez-Almazor ME. (Mis)understanding in patient-health care provider communication about total knee replacement. Arthritis Rheum. 2009;61:100–7.
- Bruera E, Willey JS, Palmer JL, Rosales M. Treatment decisions for breast carcinoma: patient preferences and physician perceptions. Cancer. 2002;94:2076–80. CrossRef
- Jackson JL. Communication about symptoms in primary care: impact on patient outcomes. J Altern Complement Med. 2005;11 Suppl 1:S51–6.
- Staiger TO, Jarvik JG, Deyo RA, Martin B, Braddock CH III. BRIEF REPORT: Patient-physician agreement as a predictor of outcomes in patients with back pain. J Gen Intern Med. 2005;20:935–7. CrossRef
- Starfield B, Wray C, Hess K, Gross R, Birk PS, D'Lugoff BC. The influence of patient-practitioner agreement on outcome of care. Am J Public Health. 1981;71:127–31. CrossRef
- Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA. 1984;252:2990–4. CrossRef
- Willems S, De MS, Deveugele M, Derese A, De MJ. Socio-economic status of the patient and doctor-patient communication: does it make a difference? Patient Educ Couns. 2005;56:139–46. CrossRef
- Suarez-Almazor ME, Conner-Spady B, Kendall CJ, Russell AS, Skeith K. Lack of congruence in the ratings of patients' health status by patients and their physicians. Med Decis Making. 2001;21:113–21.
- Teno JM, Hakim RB, Knaus WA, et al. Preferences for cardiopulmonary resuscitation: physician-patient agreement and hospital resource use. The SUPPORT Investigators. J Gen Intern Med. 1995;10:179–86. CrossRef
- Quirt CF, Mackillop WJ, Ginsburg AD, et al. Do doctors know when their patients don't? A survey of doctor-patient communication in lung cancer. Lung Cancer. 1997;18:1–20. CrossRef
- Kelly PA, Haidet P. Physician overestimation of patient literacy: a potential source of health care disparities. Patient Educ Couns. 2007;66:119–22. CrossRef
- Hall JA, Stein TS, Roter DL, Rieser N. Inaccuracies in physicians' perceptions of their patients. Med Care. 1999;37:1164–8. CrossRef
- Butow PN, Brown RF, Cogar S, Tattersall MH, Dunn SM. Oncologists' reactions to cancer patients' verbal cues. Psychooncology. 2002;11:47–58. CrossRef
- Hall JA, Horgan TG, Stein TS, Roter DL. Liking in the physician–patient relationship. Patient Educ Couns. 2002;48:69–77. CrossRef
- Street RL Jr, Gordon H, Haidet P. Physicians' communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor? Soc Sci Med. 2007;65:586–98. CrossRef
- Haidet P, O'Malley KJ, Sharf BF, Gladney AP, Greisinger AJ, Street RL Jr. Characterizing explanatory models of illness in healthcare: development and validation of the CONNECT instrument. Patient Educ Couns. 2008;73:232–9. CrossRef
- Street RL Jr. Active patients as powerful communicators. In: Robinson WP, Giles H, eds. The new handbook of language and social psychology. New York: John Wiley & Sons; 2001:541–60.
- Street RL Jr, Millay B. Analyzing patient participation in medical encounters. Health Communication. 2001;13(1):61–73. CrossRef
- Street RL Jr, Cauthen D, Buchwald E, Wiprud R. Patients' predispositions to discuss health issues affecting quality of life. Fam Med. 1995;27:663–70.
- Rothschild SK. Cross-cultural issues in primary care medicine. Dis Mon. 1998;44:293–319. CrossRef
- Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9. CrossRef
- Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Annals of Internal Medicine. 2003;139:907–15.
- Garcia JA, Paterniti DA, Romano PS, Kravitz RL. Patient preferences for physician characteristics in university-based primary care clinics. Ethn Dis. 2003;13:259–67.
- van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians' perceptions of patients. Soc Sci Med. 2000;50:813–28. CrossRef
- Beach MC, Roter DL, Wang NY, Duggan PS, Cooper LA. Are physicians' attitudes of respect accurately perceived by patients and associated with more positive communication behaviors? Patient Educ Couns. 2006;62:347–54. CrossRef
- Gordon HS, Street RL Jr, Sharf BF, Souchek J. Racial differences in doctors' information-giving and patients' participation. Cancer. 2006;107:1313–20. CrossRef
- Kleinman A. Patients and healers in the context of culture. Berkeley: University of California Press; 1980.
- Leventhal H, Diefenbach MA, Leventhal EA. Illness cognition: using common sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research. 1992;16:143–63. CrossRef
- Cegala DJ, Street RL Jr, Clinch CR. The impact of patient participation on physicians' information provision during a primary care medical interview. Health Commun. 2007;21:177–85.
- Krupat E, Irish JT, Kasten LE, et al. Patient assertiveness and physician decision-making among older breast cancer patients. Soc Sci Med. 1999;49:449–57. CrossRef
- Epstein RM, Franks P, Fiscella K, et al. Measuring patient-centered communication in patient-physician consultations: Theoretical and practical issues. Soc Sci Med. 2005;61:1516–28. CrossRef
- Martin E, Russell D, Goodwin S, Chapman R, North M, Sheridan P. Why patients consult and what happens when they do. BMJ. 1991;303:289–92. CrossRef
- Heisler M, Vijan S, Anderson RM, Ubel PA, Bernstein SJ, Hofer TP. When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make? J Gen Intern Med. 2003;18:893–902. CrossRef
- Cegala DJ, Gade C, Lenzmeier BS, McClure L. Physicians' and patients' perceptions of patients' communication competence in a primary care medical interview. Health Commun. 2004;16:289–304. CrossRef
- Ogden J, Fuks K, Gardner M, et al. Doctors expressions of uncertainty and patient confidence. Patient Educ Couns. 2002;48:171–6. CrossRef
- Rohrbaugh M, Rogers JC. What did the doctor do? When physicians and patients disagree. Arch Fam Med. 1994;3:125–8. CrossRef
- Bruera E, Sweeney C, Calder K, Palmer L, Benisch-Tolley S. Patient preferences versus physician perceptions of treatment decisions in cancer care. Journal of Clinical Oncology. 2001; 2883-2885.
- Kenny DA, Veldhuijzen W, Weijden TV, et al. Interpersonal perception in the context of doctor-patient relationships: A dyadic analysis of doctor-patient communication. Soc Sci Med. 2010;70:763–8. CrossRef
- Braddock CH, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999;282:2313–20. CrossRef
- Street RL Jr, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74:295–301. CrossRef
- Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999;130:829–34.
- Wagner EH, Glasgow RE, Davis C, et al. Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv. 2001;27:63–80.
- Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor-patient communication: a review of the literature. Soc Sci Med. 1995;40:903–18. CrossRef
- Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152:1423–33.
- Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27:S110–27. CrossRef
- Ward MM, Sundaramurthy S, Lotstein D, Bush TM, Neuwelt CM, Street RL Jr. Participatory patient-physician communication and morbidity in patients with systemic lupus erythematosus. Arthritis Rheum. 2003;49:810–8. CrossRef
- Williams GC, McGregor HA, Zeldman A, Freedman ZR, Deci EL. Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychol. 2004;23:58–66. CrossRef
- Street RL, Gordon HS. Companion participation in cancer consultations. Psychooncology. 2008;17:244–51. CrossRef
- Siminoff LA, Graham GC, Gordon NH. Cancer communication patterns and the influence of patient characteristics: Disparities in information-giving and affective behaviors. Patient Educ Couns. 2006;62:355–60. CrossRef
- Gordon HS, Street RL Jr, Sharf BF, Kelly PA, Souchek J. Racial differences in trust and lung cancer patients' perceptions of physician communication. J Clin Oncol. 2006;24:904–9. CrossRef
- Collins TC, Clark JA, Petersen LA, Kressin NR. Racial differences in how patients perceive physician communication regarding cardiac testing. Med Care. 2002;40:I27–34.
- Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22:1231–8. CrossRef
- Teal CR, Street RL. Critical elements of culturally competent communication in the medical encounter: A review and model. Soc Sci Med. 2009;68:533–43. CrossRef
- Charon R. Narrative and medicine. N Engl J Med. 2004;350:862–4. CrossRef
- Haidet P, Paterniti DA. "Building" a history rather than "taking" one: a perspective on information sharing during the medical interview. Arch Intern Med. 2003;163:1134–40. CrossRef
- Street RL Jr, Gordon HS. The clinical context and patient participation in post-diagnostic consultations. Patient Educ Couns. 2006;64:217–24. CrossRef
- Street RL, Jr., Slee C, Kalauokalani DK, Dean DE, Tancredi DJ, Kravitz RL. Improving physician-patient communication about cancer pain with a tailored education-coaching intervention. Patient Educ Couns. 2009.
- Cegala DJ, Post DM, McClure L. The effects of patient communication skills training on the discourse of older patients during a primary care interview. J Am Geriatr Soc. 2001;49:1505–11. CrossRef
- Clayton JM, Butow PN, Tattersall MH, et al. Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care. J Clin Oncol. 2007;25:715–23. CrossRef
- Kim SP, Knight SJ, Tomori C, et al. Health literacy and shared decision making for prostate cancer patients with low socioeconomic status. Cancer Invest. 2001;19:684–91. CrossRef
- Street RL Jr, Voigt B, Geyer C Jr, Manning T, Swanson GP. Increasing patient involvement in choosing treatment for early breast cancer. Cancer. 1995;76:2275–85. CrossRef
- Anderson LA, DeVellis BM, DeVellis RF. Effects of modeling on patient communication, satisfaction, and knowledge. Med Care. 1987;25:1044–56. CrossRef
- Montgomery AA, Fahey T, Peters TJ. A factorial randomised controlled trial of decision analysis and an information video plus leaflet for newly diagnosed hypertensive patients. Br J Gen Pract. 2003;53:446–53.
- Weiner SJ. Contextualizing medical decisions to individualize care: lessons from the qualitative sciences. J Gen Intern Med. 2004;19:281–5. CrossRef
- Lang F, Floyd MR, Beine KL. Clues to patients' explanations and concerns about their illnesses. A call for active listening. Arch Fam Med. 2000;9:222–7. CrossRef
- Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000;284:1021–7. CrossRef
- Weiner SJ, Schwartz A, Yudkowsky R, et al. Evaluating physician performance at individualizing care: a pilot study tracking contextual errors in medical decision making. Med Decis Making. 2007;27:726–34. CrossRef
- Thompson BM, Teal CR, Scott SM, Manning SN, Greenfield E, Shada R, Haidet P. Following the clues: Teaching medical students to explore patients' contexts. Patient Educ.Couns. 2010, in press.
- How Well Do Doctors Know their Patients? Factors Affecting Physician Understanding of Patients’ Health Beliefs
Journal of General Internal Medicine
Volume 26, Issue 1 , pp 21-27
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- physician-patient relationship
- racial concordance
- patient-centered communication
- patient participation
- Industry Sectors
- Author Affiliations
- 1. Department of Communication, Texas A&M University, College Station, TX, 77843-4234, USA
- 2. The Houston Center for Quality of Care and Utilization Studies and Baylor College of Medicine at the Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- 3. The Office of Medical Education and the Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA