Specialties Differ in Which Aspects of Doctor Communication Predict Overall Physician Ratings
- 837 Downloads
Effective doctor communication is critical to positive doctor–patient relationships and predicts better health outcomes. Doctor communication is the strongest predictor of patient ratings of doctors, but the most important aspects of communication may vary by specialty.
To determine the importance of five aspects of doctor communication to overall physician ratings by specialty.
For each of 28 specialties, we calculated partial correlations of five communication items with a 0–10 overall physician rating, controlling for patient demographics.
Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS®) 12-month Survey data collected 2005–2009 from 58,251 adults at a 534-physician medical group.
CG-CAHPS includes a 0 (“Worst physician possible”) to 10 (“Best physician possible”) overall physician rating. Five doctor communication items assess how often the physician: explains things; listens carefully; gives easy-to-understand instructions; shows respect; and spends enough time.
Physician showing respect was the most important aspect of communication for 23/28 specialties, with a mean partial correlation (0.27, ranging from 0.07 to 0.44 across specialties) that accounted for more than four times as much variance in the overall physician rating as any other communication item. Three of five communication items varied significantly across specialties in their associations with the overall rating (p < 0.05).
All patients valued respectful treatment; the importance of other aspects of communication varied significantly by specialty. Quality improvement efforts by all specialties should emphasize physicians showing respect to patients, and each specialty should also target other aspects of communication that matter most to their patients. The results have implications for improving provider quality improvement and incentive programs and the reporting of CAHPS data to patients. Specialists make important contributions to coordinated patient care, and thus customized approaches to measurement, reporting, and quality improvement efforts are important.
KEY WORDSdoctor–patient relationship specialty care quality improvement patient satisfaction
This study was supported by a cooperative agreement from the Agency for Healthcare Research and Quality (U18 HS016980). Ron D. Hays was also supported in part by grants from the NIA (P30-AG021684) and the NIMHD (P20MD000182). The authors would like to thank Aneetha Ramadas, AB, Daisy Montfort, AB, and Fergal McCarthy, MPhil, for assistance with the preparation of the manuscript.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 2.Beck R, Daughtridge R, Sloane P. Physician-patient communication in the primary care office: a systematic review. J Am Board Fam Med. 2002;15(1):25–38.Google Scholar
- 9.Wilkins V, Elliott MN, Richardson A, Lozano P, Mangione-Smith R. The association between care experiences and parent ratings of care for different racial, ethnic, and language groups in a Medicaid population. Health Serv Res. 2011;46(3):821–839. doi: 10.1111/j.1475-6773.2010.01234.x.PubMedCentralPubMedCrossRefGoogle Scholar
- 10.Ruiz-Moral R, Perez Rodriguez E, Perula de Torres LA, de la Torre J. Physician-patient communication: a study on the observed behaviours of specialty physicians and the ways their patients perceive them. Patient Educ Couns. 2006;64(1–3):242–248. doi: 10.1016/j.pec.2006.02.010.PubMedCrossRefGoogle Scholar
- 13.Roter D, Hall JA. Doctors talking with patients/patients talking with doctors : improving communication in medical visits. Westport, Conn: Auburn House; 1992.Google Scholar
- 15.Stewart MA. Effective physician-patient communication and health outcomes: a review. Can Med Assoc J. 1995;152(9):1423–1433.Google Scholar
- 18.Nagy V. Clinician–patient communication: its big impact on health. Perm J. 2001;5(4):45–47.Google Scholar
- 30.Kahn JM, Scales DC, Au DH, Carson SS, Curtis JR, Dudley RA, et al. An official American Thoracic Society Policy statement: pay-for-performance in pulmonary, critical care, and sleep medicine. Am J Respir Crit Care Med. 2010;181(7):752–761. doi: 10.1164/rccm.200903-0450ST.PubMedCrossRefGoogle Scholar
- 41.Elliott MN, Haviland AM, Kanouse DE, Hambarsoomian K, Hays RD. Adjusting for subgroup differences in extreme response tendency in ratings of health care: impact on disparity estimates. Health Serv Res. 2009;44(2 Pt 1):542–561. doi: 10.1111/j.1475-6773.2008.00922.x.PubMedCentralPubMedCrossRefGoogle Scholar
- 49.Ngo-Metzger Q, Telfair J, Sorkin D, Weidmer B, Weech-Maldonado R, Hurtado M, et al. Cultural competency and quality of care: obtaining the patient’s perspective. New York, NY: Commonwealth Fund 2006 Contract No.: 963.Google Scholar
- 52.Roland M, Elliott M, Lyratzopoulos G, Barbiere J, Parker RA, Smith P, et al. Reliability of patient responses in pay for performance schemes: analysis of national general practitioner patient survey data in England. BMJ. 2009;339:b3851. doi: 10.1136/bmj.b3851.PubMedCentralPubMedCrossRefGoogle Scholar