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Policy PointsThe meaning of health in health care remains poorly defined, defaulting to a narrow, biomedical disease model. A national dialogue could create a consensus regarding a holistic and humanized definition of health that promotes health care transformation and health equity.Key steps for operationalizing a holistic meaning of health in health care include national leadership by federal agencies, intersectoral collaborations that include diverse communities, organizational and cultural change in medical education, and implementation of high‐quality primary care.The 2023 report by the National Academies of Sciences, Engineering, and Medicine on achieving whole health offers recommendations for action. [ABSTRACT FROM AUTHOR]

Background: Patient gender and race, and physician–patient communication are associated with clinical outcomes. Aim: To understand the role of these factors in the diagnosis of colorectal cancer (CRC) during primary care visits as measured by appropriate outcome. Materials and Methods: Caucasian and African American unannounced standardized patients (USPs) of both genders presented to 207 primary care physicians (PCPs) from community and academic practices in Ohio and Virginia as new patients with CRC symptoms. PCPs were blinded to the diagnosis. Physician subjects consented to audiotaping the encounter. Medical records were obtained. Communication elements were coded by trained observers and appropriate visit outcomes were coded from the medical record and audiofiles, defined as (1) recommendation for colonoscopy/sigmoidoscopy/fecal occult blood test (FOBT) or (2) referral to gastroenterologist. Results: A total of 141 of 367 USP visits (38%) resulted in appropriate clinical outcomes. Patient race was not associated with outcome, but being a male USP was (χ2 = 4.12, p = 0.04). Relational communication was represented as a latent variable with seven indicators (alpha = 0.84) and was independently associated with outcome (beta = 0.15; p = 0.025). After controlling for clustered sampling, relational communication, and race, structural equational modeling indicated that female USPs were less likely to have an appropriate clinical visit outcome (beta = −0.13; p = 0.033). Conclusions: Using a novel and innovative methodology capturing PCP behaviors during real-time clinician–patient interaction, appropriate clinical outcome was independently associated with being male and PCP relational communication factors such as encouraging patient communication, being engaged and expressive in the physician–patient conversation, and appearing friendly and sincere. There are persistent biases in the delivery of health care to female patients and further research into targeted communication skills programs may be warranted. [ABSTRACT FROM AUTHOR]

Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific behavior changes and the most appropriate action is dependent on the patient's preferences. Many clinical consultations may require elements of both approaches, however. This article describes these 2 approaches—one to address ambivalence to medically indicated behavior change and the other to support patients in making health care decisions in cases where there is more than one reasonable option—and discusses how clinicians can draw on these approaches alone and in combination to achieve patient-centered care across the range of health care problems. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Commercial advertising and patient education have separate theoretical underpinnings, approaches, and practitioners. This paper aims to describe a collaboration between academic researchers and a marketing firm working to produce demographically targeted public service anouncements (PSAs) designed to enhance depression care-seeking in primary care. Methods: An interdisciplinary group of academic researchers contracted with a marketing firm in Rochester, NY to produce PSAs that would help patients with depressive symptoms engage more effectively with their primary care physicians (PCPs). The researchers brought perspectives derived from clinical experience and the social sciences and conducted empirical research using focus groups, conjoint analysis, and a population-based survey. Results were shared with the marketing firm, which produced four PSA variants targeted to gender and socioeconomic position. Results: There was no simple, one-to-one relationship between research results and the form, content, or style of the PSAs. Instead, empirical findings served as a springboard for discussion and kept the creative process tethered to the experiences, attitudes, and opinions of actual patients. Reflecting research findings highlighting patients’ struggles to recognize, label, and disclose depressive symptoms, the marketing firm generated communication objectives that emphasized: (a) educating the patient to consider and investigate the possibility of depression; (b) creating the belief that the PCP is interested in discussing depression and capable of offering helpful treatment; and (c) modelling different ways of communicating with physicians about depression. Before production, PSA prototypes were vetted with additional focus groups. The winning prototype, “Faces,” involved a multi-ethnic montage of formerly depressed persons talking about how depression affected them and how they improved with treatment, punctuated by a physician who provided clinical information. A member of the academic team was present and consulted closely during production. Challenges included reconciling the marketing tradition of audience segmentation with the overall project goal of reaching as broad an audience as possible; integrating research findings across dimensions of words, images, music, and tone; and dealing with misunderstandings related to project scope and budget. Conclusion: Mixed methods research can usefully inform PSAs that incorporate patient perspectives and are produced to professional standards. However, tensions between the academic and commercial worlds exist and must be addressed. Practice implications: While rewarding, academic-marketing collaborations introduce tensions which must be addressed. [Copyright &y& Elsevier]

The article discusses the significance of shared mind in the decision making in clinical practice in the context of serious illness. It explores how shared mind, which involve sharing of information, thoughts, feelings, perceptions, meanings, and intentions, can be shared through communication and its implication for decision making and patient autonomy. Moreover, patient-centered approaches to patient-clinician interactions have been considered to promote relational autonomy.

The article discusses the lack of primary care for patients in the U.S. It mentions that visiting physicians for 15 minutes is not enough to fully examine a patient. In addition, it emphasizes the need to focus on health care of less fortunate people because they are the ones who have often afflicted with diseases. According to the authors, training of health care workforce is vital to attend to every patient with different disorders and illnesses. They likewise mention the importance of preventive care to avoid further complications.

Background: Effective treatments can be rendered useless by poor patient recall of treatment instructions. Studies suggest that patients forget a great deal of important information and that recall can be increased through recall-promoting behaviors (RPBs) like repetition or summarization.Objective: To assess how frequently RPBs are used in primary care, and to reveal how they might be applied more effectively.Design: Recordings of 49 unannounced standardized patient (SP) visits were obtained using hidden audiorecorders. All SPs presented with typical gastroesophageal reflux disease symptoms. Transcripts were coded for treatment recommendations and RPBs.Participants: Forty-nine primary care physicians.Results: Of 1,140 RPBs, 53.7% were repetitions, 28.2% were communication of the rationale for a treatment, 11.7% were categorizations of treatments (i.e., stating that a treatment could be placed into a treatment category, such as medication-related or lifestyle-related categories), and 3.8% were emphasis of a recommendation's importance. Physicians varied substantially in their use of most RPBs, although no physicians summarized or asked patients to restate recommendations. The number of RPBs was positively correlated with visit length.Conclusions: Primary care physicians apply most RPBs inconsistently, do not utilize several RPBs that are particularly helpful, and may use RPBs inefficiently. Simple principles guiding RPB use may help physicians apply these communication tools more effectively. [ABSTRACT FROM AUTHOR]

The article presents a study of the effects of physician communication behaviors on relationships between patient request for antidepressant medications and prescribing. Researchers made a secondary analysis of a randomized trial and coded covert visit audio recordings for physicians' exploration and validation of patient concerns. It has been found that quality of care for depression is improved when patients participate actively in the encounter and when physicians validate patient concerns.

Background: Referral from primary care to the mental health specialty sector is important but poorly understood.Objective: Identify physician characteristics influencing mental health referral.Design: Randomized controlled trial using Standardized Patients (SPs).Setting: Offices of primary care physicians in 3 cities.Participants: One hundred fifty-two family physicians and general internists recruited from 4 broad practice settings; 18 middle aged Caucasian female actors.Intervention: Two hundred and ninety-eight unannounced SP visits, with assignments constrained so physicians saw 1 SP with major depression and 1 with adjustment disorder.Measurements: Mental health referrals via SP written reports; physician and system characteristics through a self-administered physician questionnaire.Results: Among 298 SP visits, 107 (36%) resulted in mental health referral. Referrals were less likely among physicians with greater self-confidence in their ability to manage antidepressant therapy (adjusted odds ratio [AOR] 0.39, 95% confidence interval [CI] 0.17 to 0.86) and were more likely if physicians typically spent > or =10% of professional time on nonclinical activities (AOR 3.42, 95% CI 1.45 to 8.07), had personal life experience with psychotherapy for depression (AOR 2.74, 95% CI 1.15 to 6.52), or usually had access to mental health consultation within 2 weeks (AOR 2.94, 95% CI 1.26 to 6.92).Limitation: The roles portrayed by SPs may not reflect the experience of a typical panel of primary care patients.Conclusions: Controlling for patient and health system factors, physicians' therapeutic confidence and personal experience were important influences on mental health referral. Research is needed to determine if addressing these factors can facilitate more appropriate care. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To explore limitations of current communication theory by considering different perspectives of researchers, clinicians, patients and teachers of communication. Method: Theory development based on limitations of the current communication research literature due to inconsistencies between patient reports and observed communication behavior. Results: While researchers focus on the mechanics and techniques of communication, patients seek relationships in which they experience trust, the right amount of autonomy, caring, and expertise. Patients’, physicians’, and communication experts’ perspectives do not always define the same problems and often point to different solutions. Conclusions: In addition to studying clinician behaviors and patient perceptions of care, communication research should focus on five additional factors: what patients notice, want and need, and how their perspectives differ from those of physicians and researchers; the context, including illness severity and type and family influences; how complex health systems facilitate and impede communication; patients’ influences on physician communication behavior; and habits of mind that promote attentive care. [Copyright &y& Elsevier]

Abstract: The goal of patient-centered communication (PCC) is to help practitioners provide care that is concordant with the patient''s values, needs and preferences, and that allows patients to provide input and participate actively in decisions regarding their health and health care. PCC is widely endorsed as a central component of high-quality health care, but it is unclear what it is and how to measure it. PCC includes four communication domains: the patient''s perspective, the psychosocial context, shared understanding, and sharing power and responsibility. Problems in measuring PCC include lack of theoretical and conceptual clarity, unexamined assumptions, lack of adequate control for patient characteristics and social contexts, modest correlations between survey and observational measures, and overlap of PCC with other constructs. We outline problems in operationalizing PCC, choosing tools for assessing PCC, choosing data sources, identifying mediators of PCC, and clarifying outcomes of PCC. We propose nine areas for improvement: (1) developing theory-based operational definitions of PCC; (2) clarifying what is being measured; (3) accounting for the communication behaviors of each individual in the encounter as well as interactions among them; (4) accounting for context; (5) validating of instruments; (6) interpreting patient ratings of their physicians; (7) doing longitudinal studies; (8) examining pathways and mediators of links between PCC and outcomes; and (9) dealing with the complexity of the construct of PCC. We discuss the use of observational and survey measures, multi-method and mixed-method research, and standardized patients. The increasing influence of the PCC literature to guide medical education, licensure of clinicians, and assessments of quality provides a strong rationale for further clarification of these measurement issues. [Copyright &y& Elsevier]

Abstract: Objectives:: To develop a reliable and valid computer coded measure to assess emotional expression from transcripts of physician–patient interactions. Methods:: Physician encounters with two standardized patients (SPs) were audiotaped. Fifty patients from each physician (n = 100 primary care physicians) completed surveys that assessed patients’ perceptions of their relationships with physicians. Audio-recordings of 193 patient-physician encounters were transcribed and computer-coded to derive a percent emotion words, and research assistants completed the Measure of Patient-Centered Communication (MPCC). Results:: After adjustment for potential confounders, regression analyses revealed physicians’ use of emotion words and the MPCC contribute independently to patients’ and SPs’ perceptions of their relationship with physicians. Conclusions:: The computerized coding of emotion words shows promise as a reliable, valid, and simple method to code transcript data of physician–patient interactions. This method may be expanded to examine other aspects of physician language and does not require coder training. [Copyright &y& Elsevier]

Purpose: Observational studies using patient reports suggest associations between physician interpersonal styles and patient outcomes. Possible confounding of these associations has not been carefully examined.Methods: Approximately 4,700 patients of 96 physicians completed a survey instrument that included reported health status changes during the previous year, perceptions of their physician (satisfaction, trust, knowledge of patient, and autonomy support), and sociodemographic and clinical covariates. We examined the adjusted relationship between patient perceptions of their physicians and reported health status changes. Using multilevel analyses, we then explored differences among physicians in patient perceptions of their physicians and whether these differences were explained by the relationship between patient perceptions and reported health status changes.Results: There were significant adjusted relationships between patient perceptions of their physician and reported health status changes: better perceptions were associated with a smaller risk of health status decline (adjusted odds ratio = 1.14; 95% confidence interval [CI], 1.05-1.24; P <.01). Multilevel analysis showed significant differences between physicians in patient perceptions of their physicians (rho = 0.10; 95% CI, 0.07-0.13; P <.01), but these physician differences were unrelated to reported health status decline (rho = 0; P >.99).Conclusions: Using methods similar to those of previous studies, we found a relationship between patient perceptions of their physicians and reported health status declines. Multilevel analysis, however, suggested that this relationship is not a physician effect; it may reflect unmeasured patient confounding. Multilevel analyses may help to examine the relationships between physician styles and outcomes. [ABSTRACT FROM AUTHOR]

Context: Direct-to-consumer (DTC) advertising of prescription drugs in the United States is both ubiquitous and controversial. Critics charge that it leads to overprescribing, while proponents counter that it helps avert underuse of effective treatments, especially for conditions that are poorly recognized or stigmatized. Objective: To ascertain the effects of patients’ DTC-related requests on physicians’ initial treatment decisions in patients with depressive symptoms. Design: Randomized trial using standardized patients (SPs). Six SP roles were created by crossing 2 conditions (major depression or adjustment disorder with depressed mood) with 3 request types (brand-specific, general, or none). Setting: Offices of primary care physicians in Sacramento, Calif; San Francisco, Calif; and Rochester, NY, between May 2003 and May 2004. Participants: One hundred fifty-two family physicians and general internists recruited from solo and group practices and health maintenance organizations; cooperation rates ranged from 53% to 61%. Interventions: The SPs were randomly assigned to make 298 unannounced visits, with assignments constrained so physicians saw 1 SP with major depression and 1 with adjustment disorder. The SPs made a brand-specific drug request, a general drug request, or no request (control condition) in approximately one third of visits. Main Outcome Measures: Data on prescribing, mental health referral, and primary care follow-up obtained from SP written reports, visit audiorecordings, chart review, and analysis of written prescriptions and drug samples. The effects of request type on prescribing were evaluated using contingency tables and confirmed in generalized linear mixed models that accounted for clustering and adjusted for site, physician, and visit characteristics. Results: Standardized patient role fidelity was excellent, and the suspicion rate that physicians had seen an SP was 13%. In major depression, rates of antidepressant prescribing were 53%, 76%, and 31% for SPs making brand-specific, general, and no requests, respectively (P<.001). In adjustment disorder, antidepressant prescribing rates were 55%, 39%, and 10%, respectively (P<.001). The results were confirmed in multivariate models. Minimally acceptable initial care (any combination of an antidepressant, mental health referral, or follow-up within 2 weeks) was offered to 98% of SPs in the major depression role making a general request, 90% of those making a brand-specific request, and 56% of those making no request (P<.001). Conclusions: Patients’ requests have a profound effect on physician prescribing in major depression and adjustment disorder. Direct-to-consumer advertising may have competing effects on quality, potentially both averting underuse and promoting overuse. [ABSTRACT FROM AUTHOR]

Examines the significance of biopsychosocial model of clinical care. Importance of the model as a way of understanding how suffering, disease, and illness are affected by multiple levels of organization; Proposal of a biopsychosocial-oriented clinical practice; Aim of George Engel to offer a dynamic, interactional, but dualistic view of human experience in which there is mutual influence of mind and body. INSET: Engel's Critique of Biomedicine.

Habits of mind, such as attentiveness, curiosity, and presence, are fundamental to effective medical practice and physician wellbeing. In this second of two articles about mindfulness, I propose an 8-fold method for promoting mindful practice in medicine: (a) Priming—setting the expectation of selfobservation, (b) Availability—creating physical and mental space for exchange, (c) Reflective questions to open up possibilities and invite curiosity, (d) Active engagement— direct observation and exchange, (e) Modeling while "thinking out loud" to make mental processes more transparent, (f) Practicing attentiveness, curiosity, and presence, (g) Praxis—consolidation of learning by experience, and (h) Assessment and confirmation. I include examples from medicine, music, and meditation. [ABSTRACT FROM AUTHOR]

In this first of a 2-part series of articles, mindfulness is defined as a purposeful, non-anxious, reflective presence that can be applied to any aspect of practice. More than an occasional flash of insight, mindfulness is a state of mind that permits insight, presence, and reflection. Mindfulness applies equally to cognitive, technical, and interpersonal aspects of medicine, and invites a deeper examination of the process of care. Mindful practice includes core features: attentive observation, critical curiosity, "beginner's mind," and presence. Mindfulness can be recognized, and requires practice to become habitual. Although mindfulness is not taught explicitly in medical training, it is often invoked through clinical stories and by observing exemplary practitioners. Levels of mindfulness extend from mindless imitation to embodied presence, and are described in the text. [ABSTRACT FROM AUTHOR]

Presents a study to examine the extent to which experienced family physicians in various practice settings elicit the agenda of concerns patients bring to the office. Design; Setting and participants; Main outcome measures; Results; Conclusions.

The author reflects on a study by M. Stewart and colleagues in this same issue of "The Journal of Family Practice" about patient-centered care. He points out the correlation between patients' perceptions and health care outcomes. He emphasizes the importance of communication in the practice of medicine. He explains the influence of the quality of physician-patient relationship on patient-centredness.

In this issue of the Journal of General Internal Medicine, three articles address the complex influence of external regulation of health care systems on perceptions of time, professional and patient satisfaction, and medical education. The articles address the effects of several rapidly evolving directions in the financing of health care and regulations controlling health professions education. These systems factors have unintentionally placed the interests of patients, physicians, and trainees in conflict. Although time is often the focus of these conflicts, I believe that the issue is much deeper and more complex. In this issue of JGIM, Linzer et al.[sup 3] report on a carefully designed cross-sectional study of 5,704 physicians. They found that perceived time pressure is associated with lower physician satisfaction, and that both time pressure and lower physician satisfaction are more common in HMO settings. The data presented in this study reflect a realistic concern about the patient-physician relationship. [ABSTRACT FROM AUTHOR]

Patient involvement in decisions is central to patient-centered care. Yet many important decisions must be made in complex, ambiguous clinical situations in which all possible options cannot be known, evidence is inadequate to inform patients’ preferences fully, and/or patients are unclear about their desired level of involvement. In these situations, preferences are shaped by affect, framing, and “collaborative cognition” among clinicians, patients, and their families; thus, decisions are often relational, dynamic, iterative, provisional, and/or conditional. Clinicians can help patients achieve greater autonomy by engaging both intuitive and deliberative decision-making processes (“whole mind”) and involving others in exploring, clarifying, and co-constructing patients’ preferences (“shared mind”). Clinical and interpersonal relationships can promote effective decision making through developing a shared attentional focus, tailoring information, and identifying conditions under which provisional preferences might change. Information technology and health systems offer untapped potential to deepen the relationships and conversations within which decisions are made. [ABSTRACT FROM AUTHOR]

Growing enthusiasm about patient-centered medical homes, fueled by the Patient Protection and Affordable Care Act's emphasis on improved primary care, has intensified interest in how to deliver patient-centered care. Essential to the delivery of such care are patient-centered communication skills. These skills have a positive impact on patient satisfaction, treatment adherence, and self-management. They can be effectively taught at all levels of medical education and to practicing physicians. Yet most physicians receive limited training in communication skills. Policy makers and stakeholders can leverage training grants, payment incentives, certification requirements, and other mechanisms to develop and reward effective patient-centered communication. [ABSTRACT FROM AUTHOR]

Context: Previous studies from the U.S. and Canada report deficiencies in informed decision making and a need to improve end-of-life (EoL) care in patients undergoing dialysis. However, there is a paucity of literature on these issues in Pakistani dialysis patients, who differ from Western patients in culture, religion, and available health care services.Objectives: To study informed dialysis decision-making and EoL attitudes and beliefs in Pakistani patients receiving dialysis.Methods: We used convenience sampling to collect 522 surveys (90% response rate) from patients in seven different dialysis units in Pakistan. We used an existing dialysis survey tool, translated into Urdu, and backtranslated to English. A facilitator distributed the survey, explained questions, and orally administered it to patients unable to read.Results: Less than one-fourth of the respondents (23%) felt informed about their medical condition, and 45% were hopeful that their condition would improve in the future. More than half (54%) wished to know their prognosis, and 80% reported having no prognostic discussion. Almost 63% deemed EoL planning important, but only 5% recalled discussing EoL decisions with a doctor during the last 12 months. Nearly 62% of the patients regretted their decision to start dialysis. Patients' self-reported knowledge of hospice (5%) and palliative care (7.9%) services was very limited, yet 46% preferred a treatment plan focused on comfort and symptom management rather than life extension.Conclusion: Pakistani patients reported a need for better informed dialysis decision making and EoL care and better access to palliative care services. These findings underscore the need for palliative care training of Pakistani physicians and in other developing countries to help address communication and EoL needs of their dialysis patients. [ABSTRACT FROM AUTHOR]

Prior interventions have repeatedly failed to decrease the prescription and receipt of treatments and procedures that confer more harm than benefit at the End-of-Life (EoL); new approaches to intervention are needed. Ideally, future interventions would be informed by a social-ecological conceptual model that explains EoL healthcare utilization patterns, but current models ignore two facts: (1) healthcare is an inherently social activity, involving clinical teams and patients' social networks, and (2) emotions influence social activity. To address these omissions, we scaffolded Terror Management Theory and Socioemotional Selectivity Theory to create the Tr anstheoretical Model of I rrational B iomedical E xuberance (TRIBE). Based on Terror Management Theory, TRIBE suggests that the prospect of patient death motivates healthcare teams to conform to a biomedical norm of care, even when clinicians believe that biomedical interventions will likely be unhelpful. Based on Socioemotional Selectivity Theory, TRIBE suggests that the prospect of dwindling time motivates families to prioritize emotional goals, and leads patients to consent to disease-directed treatments they know will likely be unhelpful, as moral emotions motivate deference to the perceived emotional needs of their loved ones. TRIBE is unique among models of healthcare utilization in its acknowledgement that moral emotions and processes (e.g., shame, compassion, regret-avoidance) influence healthcare delivery, patients' interactions with family members, and patients' outcomes. TRIBE is especially relevant to potentially harmful EoL care in the United States, and it also offers insights into the epidemics of overtreatment in healthcare settings worldwide. By outlining the role of socioemotional processes in the care of persons with serious conditions, TRIBE underscores the critical need for psychological innovation in interventions, health policy and research on healthcare utilization. • Many interventions, treatments and procedures confer more harm than benefit at the End-of-Life. • To explain why this happens, we developed the Transtheoretical Model of Irrational Biomedical Exuberance (TRIBE). • The TRIBE model highlights the role of moral emotions (e.g., guilt), motives (regret-avoidance) and processes (e.g., compassion) in healthcare. • TRIBE underscores the critical need for psychological innovation in healthcare delivery and the education of health professionals. [ABSTRACT FROM AUTHOR]

Objective: Patient navigation for cancer care assesses and alleviates barriers to health care services. We examined paired perspectives of cancer patients and their navigators to examine the process of patient navigation. We explored the strengths, limitations, and our own lessons learned about adopting the novel methodology of multiperspective analysis. Methods: As part of a larger RCT, patients and navigators were interviewed separately. We reviewed interviews with 18 patient–navigator dyads. Dyad summaries were created that explicitly incorporated both patient and navigator perspectives. Emerging themes and verbatim quotations were reflected in the summaries. Results: Paired perspectives were valuable in identifying struggles that arose during navigation. These were represented as imbalanced investment and relational amelioration. Patients and navigators had general consensus about important patient needs for cancer care, but characterized these needs differently. Conclusion: Our experience with multiperspective analysis revealed a methodology that delivers novel relational findings, but is best conducted de novo rather than as part of a larger study. Practice implications: Multiperspective analysis should be more widely adopted with clear aims and analytic strategy that strengthen the ability to reveal relational dynamics. Navigation training programs should anticipate navigator struggles and provide navigators with tools to manage them. [Copyright &y& Elsevier]

Abstract: Objective: There is considerable interest in the influences on patients’ ratings of physicians. Methods: In this cross-sectional study, patients (n =4616; age range: 18–65 years) rated their level of satisfaction with their primary care physicians (n =96). Patients and physicians were recruited from primary care practices in the Rochester, NY metropolitan area. For analytic purposes, length of the patient–physician relationship was stratified (≤1, 1–4, ≥5 years). Principal components factor analysis of items from the Health Care Climate Questionnaire, the Primary Care Assessment Survey and the Patient Satisfaction Questionnaire yielded a single factor labeled “Satisfaction” that served as the sole dependent variable. Higher scores mean greater satisfaction. Predictors of interest were patient demographics and morbidity as well as physician demographics and personality, assessed with items from the NEO-FFI. Results: Patients treated by a physician for 1 year or less rated male physicians higher than female physicians. This gender difference disappeared after 1 year, but two physician personality traits, Openness and Conscientiousness, were associated with patients’ ratings in lengthier patient–physician relationships. Patients report being more satisfied with physicians who are relatively high in Openness and average in Conscientiousness. Older patients provide higher ratings than younger patients, and those with greater medical burden rated their physicians higher. Conclusion: Patients’ ratings of physicians are multidetermined. Future research on patient satisfaction and the doctor–patient relationship would benefit from a consideration of physician personality. Identifying physician personality traits that facilitate or undermine communication, trust, patient-centeredness, and patient adherence to prescribed treatments is an important priority. Practice implications: Learning environments could be created to reinforce certain traits and corresponding habits of mind that enhance patient satisfaction. Such a shift in the culture of medical education and practice could have implications for patient care. [Copyright &y& Elsevier]