Tom Janisse

Communication Practices of Physicians With High Patient-Satisfaction Ratings

How do primary care physicians with outstanding patient-satisfaction ratings communicate with their patients? Which specific practices distinguish them from less effective communicators on the basis of measured performance? To answer this question, we videotaped 92 adult primary care visits in Southern California and Hawaii and interviewed both physicians and patients separately. Each participating physician and patient viewed the tapes of the visit and shared their perceptions of the communication aspects of the visit. We also audiotaped these debriefing sessions. To identify successful physician communication practices, exam room visit behaviors and comments from the postvisit debriefs were coded and compared with each physicians panel-level patient satisfaction. In the final section, we describe communication strategies reported by physicians with high patient-satisfaction ratings. The quality of physician-patient communication in primary care visits is related to patient satisfaction,1 adherence,2,3 litigation,4 quality of data collection,5 utilization patterns, and clinical outcomes.6 There is evidence that communications between physicians and patients are sometimes inadequate.7–9 In addition, disruptive communications reduce the quality of worklife for physicians. Thus, improvement in physician communication skills has great potential for both the quality of medical care and for the physician work environment.

A next step: reviewer feedback on quality improvement publication guidelines.

Technology and Process Improvement Dazzled by advances in surgical lasers, the anti-aging drug reservatrol, or Google’s warpspeed search of the earth’s information on their handheld computers, physicians and nurses may dismiss the significance of their recent diabetic and cardiac quality improvement (QI) work that arguably improves health care more than many technologic advances. Despite the intensity of designing and enacting QI studies to improve the processes, reliability, and safety of medical care, doctors and nurses have historically not captured or reported their data and findings with enough systematic rigor to turn your head from the brilliance of technology or the randomized, controlled, drug trials reported online and in the media even before print publication. Their work, however, is critical because embedding and integrating new knowledge into clinical practice through quality improvement work is ultimately the outcome that will improve the state of this country’s health care.

Relationship of a Physician's Well-Being to Interactions with Patients: Practices of the Highest Performing Physicians on the Art of Medicine Patient Survey

In 2001, a pilot study was conducted in Portland, OR to explore the communication practices of physicians who scored highest on the Art of Medicine (AOM) Patient Survey (see Sidebar: Art of Medicine Attributes), five years post implementation. The 2002 published report cited five core practices that emerged from 21 top-performing physicians: courtesy and regard, atten-tion, listening, presence, and caring.

C-B3-02: Doctors? Role in Their Patient?s Healing: Practices of the Highest Performing Physicians by Patient Survey.

Background and Aims: The MD-Patient Communication Study aims were the best practice communication behaviors of physicians during outpatient clinic visits; and to collect physician perspectives of communication behaviors. Researchers have consistently found the top predictors of overall patient satisfaction are quality of the physician-patient relationship and contributing communications. There is limited understanding however, of the range of specific behaviors in the interaction associated with positive and negative patient perceptions and reactions. Methods: In phase 1, we conducted a naturalistic, observational study of fifty-five, Permanente Primary Care physician-patient visits using videotape recordings, and incorporating patient and physician reactions to the tape. The physicians, who practiced in Los Angeles and Honolulu, spanned the three strata of high, medium, and low historical patient satisfaction scores. In phase 2, a standardized six-question set was posed, in semi-structured, 60-minute interviews, to 77 of the highest-performing physicians on this patient survey, including: 20 of the highest performers (top 5%) from the LA and Honolulu groups; and 42 and 15, respectively, of the highest performing physicians in Portland and Oakland. These interviews were audio taped with permission, transcribed and coded for patterns. Results: This abstract addresses the 4th question: “What role do you feel you play in your patients’ healing? Do you think you, as a doctor, contribute to your patients’ healing through nontechnical, non-physical, or non-scientific ways?” All physicians agreed but varied in their role. Representative quotes: “Giving people the confidence to go through something.” “People feel better coming in and seeing/talking to you.” “People realizing they have the power to heal themselves–their involvement is essential.” “Our relationship: interpersonal connection is so powerful.” “The art of medicine is the art of healing.” These narratives provide deep, coherent learning about physicians’ role in healing: relationship, education, empowerment, emotion, personal connection, hope. Conclusions: With primary care in crisis nationally, and specialists increasingly procedure-focused, understanding physicians’ role in patients’ healing, especially as it creates high patient satisfaction, is of great importance to sustaining the highest quality medical care and service.

Writing and telling our clinical stories to improve the art of medicine.

Why do doctors and nurses write stories? And why tell them to a group of unfamiliar colleagues? People write to learn from their experiences, to express the meaning of their lifes work. Although we remember our stories, we may not understand them until we write them on paper, move them out into the world.

Stories Tell Us What We Need To Know: Perspective for Ethical Dilemmas—The Story Study

(Portions of the text, and the first story study, are excerpted from Ethics Rounds 2003–04 Winter;13(14), and from The Permanente Journal 2003 Winter;6(1) and The Permanente Journal 2004 Winter;8(1).