Physicians, Patients, and Peers Rate Communication Differently

Marcia Frellick

July 09, 2018

Physicians, patients, and peer clinical reviewers give very different ratings on physicians' communication skills in postappointment surveys, according to a study published online today in the Annals of Family Medicine.

Jenni Burt, PhD, senior social scientist at the Healthcare Improvement Studies Institute at University of Cambridge in the United Kingdom, and colleagues, found no correlation between physician and patient scores (0.009; P = .854) or between scores of physicians and trained peer clinical raters (–0.006; P = .69). There was a moderate and significant correlation between patient and clinical rater scores (0.35; P = .042).

Burt and colleagues say their analysis shows that physicians may not be fully aware of what patients and peer observers think is good communication. They conclude that assessment by outside peers is an effective approach to identify communication gaps and an important addition for improving the quality of healthcare.

Outside Raters a First Step in Improving Communication

"Our study provides further evidence for the importance of external assessment of physicians' communication skills by trained peers as a first step in improving the standard of physician-patient communication," the authors write.

Burt and colleagues analyzed survey results from patients who had appointments with 45 family physicians at 13 practices in England.

Participants included 503 pairs of physicians and patients who completed a seven-item questionnaire on how well information was communicated. Questions addressed areas such as how well treatments were explained and whether the physician listened well and took problems seriously. In addition, trained clinical raters, all family physicians themselves, assessed a sample of 55 of the videotaped sessions by using the same seven questions.

Patient, physician, and rater scores were then compared using correlation coefficients.

Physicians scored themselves, on average, lower than patients scored them (average physician score, 74.5; average patient score, 94.4); 63.4% of patients gave physicians the maximum of 100. However, the average rater score was 57.3%.

Because the scores are so different, evaluation of physicians' communication skills may need to incorporate more than just patient satisfaction scores, the authors say. Patients tend to rate physicians higher than physicians rate themselves and higher than do trained clinical raters, which may be partially due to some patients being inhibited about identifying bad experiences on a questionnaire, the authors say.

The multisource approach for evaluating physician communication is used in the United Kingdom, where the General Medical Council requires all physicians to have patient and colleague feedback as part of supporting information for the renewal of their license to practice, the authors note.

 "Patient feedback is, and should remain, a central component of assessments of the quality of care. Our findings, however, support the role of trained peer assessors in examining the communication practices of physicians in any multisource assessment investigating standards of care," they write.

"We would further suggest that the presentation of feedback from such assessments should include support for physicians to better attune themselves to the perceptions and communication needs of their patients."

Practices were eligible if they had more than one family physician working a minimum of 2 days a week in direct clinical contact with patients and had low scores on physician-patient communication in the 2009-2010 national [general practitioner] Patient Survey.

Although the researchers acknowledge the choice of practices may be a possible study limitation, in that it could contribute to selection bias, they write, "[W]e specifically sought low-scoring practices to maximize the chance of some appointments within the practice being given low patient ratings for communication."

In England, 94% of patients score all questions addressing physician communication during appointments as good or very good, the authors explain.

The study was funded by the National Institute for Health Research Programme. Burt is an adviser to National Health Service England on the GP Patient Survey. Coauthors have been advisers to Ipsos MORI, the Department of Health, and subsequently NHS England on the development of the English GP Patient Survey.

Ann Fam Med. 2018;16:330-337. Abstract

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