Search

Objectives: To describe and deepen our understanding of patient-centeredness, empathy, and boundary management in challenging conversations. Previous studies show frequent physician self-disclosure, while empathy and boundary management are infrequent., Methods: Three standardized patients (SPs) portrayed cancer patients consulting a new community-based physician, resulting in 39 audio-recorded SP visits to 19 family physicians and 20 medical oncologists. Transcripts underwent qualitative iterative thematic analysis, informed by grounded theory, followed by directed content analysis. We further defined the identified communicative categories with descriptive and correlational calculations., Results: We identified patient-centered physician response categories--empathy, affirmation, and acknowledgement; and physician-centered categories-transparency, self-disclosure, and projection. Acknowledgement and affirmation responses were frequent and empathy rare. Physician transparency and self-disclosure were common. Useful and not useful self-disclosures were highly correlated; empathy, useful and not useful transparency, and projection were moderately correlated. Most physicians used self-disclosure but few of these were judged patient-centered., Conclusions: Physicians expressing empathy and patient-centered transparency were also more likely to use projection and physician-centered transparency, thus engaging in communication "boundary turbulence." Patients may benefit from physicians' improved use of empathy and boundary management., Competing Interests: Competing interests None reported. Declarations of interest None., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Teamwork is critical to providing excellent healthcare, and effective communication is essential for teamwork. Physicians often discuss patient referrals from other physicians, including referrals from outside their primary institution. Sharing conflicting information or negative judgments of other physicians to patients may be unprofessional. Poor teamwork within healthcare systems has been associated with patient mortality and lower staff well-being., Objective: This analysis explored how physicians talk to patients with advanced cancer about care rendered by other physicians., Design: Standardized patients (SPs) portraying advanced lung cancer attended covertly recorded visits with consenting oncologists and family physicians., Participants: Twenty community-based oncologists and 19 family physicians had encounters with SPs., Approach: Physician comments about care by other physicians were extracted from transcriptions and analyzed qualitatively. These comments were categorized as Supportive or Critical. We also examined whether there were differences between physicians who provide supportive comments and those who provided critical comments., Key Results: Fourteen of the 34 encounters (41 %) included in this analysis contained a total of 42 comments about the patient's previous care. Twelve of 42 comments (29 %) were coded as Supportive, twenty-eight (67 %) as Critical, and two (4 %) as Neutral. Supportive comments attributed positive qualities to another physician or their care. Critical comments included one specialty criticizing another and general lack of trust in physicians., Conclusion: This study described comments by physicians criticizing other physicians to patients. This behavior may affect patient satisfaction and quality of care. Healthcare system policies and training should discourage this behavior.

Objective: To examine how primary care physicians respond to ambiguous patient symptom presentations., Design: Observational study, using thematic analysis within a larger cross-sectional study employing standardized patients (SPs), to describe physician responses to ambiguous patient symptoms and patterns of physician-patient interaction., Setting: Community-based primary care offices within a metropolitan area., Participants: Twenty-three primary care physicians (internists and family physicians)., Method: Participating physicians had 2 unannounced SP visits randomly inserted into their daily practice schedules and the visits were audiotaped and transcribed. A coding system focusing on physician responses to concerned patients presenting with ambiguous symptoms was developed through an inductive process. Thematic analyses were then applied to coded data., Results: Physicians' responses to ambiguous symptoms were categorized into 2 primary patterns: high partnering (HP) and usual care (UC). HP was characterized by greater responsiveness to patients' expression of concern, positivity, sensitivity to patients' clues about life circumstances, greater acknowledgment of symptom ambiguity, and solicitation of patients' perspectives on their problems. UC was characterized by denial of ambiguity and less inclusion of patients' perspectives on their symptoms. Neither HP physicians nor UC physicians actively included patients in treatment planning., Conclusions: Primary care physicians respond to ambiguity by either ignoring the ambiguity and becoming more directive (UC) or, less often, by acknowledging the ambiguity and attempting to explore symptoms and patient concerns in more detail (HP). Future areas of study could address whether physicians can learn HP behaviors and whether HP behaviors positively affect health outcomes.

The article examines the effects of physician self-disclosure (MD-SD) on primary care visits. According to the authors, practicing primary care physicians disclosed information about themselves or their families in 34 percent of new visits with unannounced, undetected, standardized patients. The effect of MD-SD on patient-physician relationships is discussed.

To examine how primary care physicians respond to ambiguous patient symptom presentations. Observational study, using thematic analysis within a larger cross-sectional study employing standardized patients (SPs), to describe physician responses to ambiguous patient symptoms and patterns of physician-patient interaction. Community-based primary care offices within a metropolitan area. Twenty-three primary care physicians (internists and family physicians). Participating physicians had 2 unannounced SP visits randomly inserted into their daily practice schedules and the visits were audiotaped and transcribed. A coding system focusing on physician responses to concerned patients presenting with ambiguous symptoms was developed through an inductive process. Thematic analyses were then applied to coded data. Physicians' responses to ambiguous symptoms were categorized into 2 primary patterns: high partnering (HP) and usual care (UC). HP was characterized by greater responsiveness to patients' expression of concern, positivity, sensitivity to patients' clues about life circumstances, greater acknowledgment of symptom ambiguity, and solicitation of patients' perspectives on their problems. UC was characterized by denial of ambiguity and less inclusion of patients' perspectives on their symptoms. Neither HP physicians nor UC physicians actively included patients in treatment planning. Primary care physicians respond to ambiguity by either ignoring the ambiguity and becoming more directive (UC) or, less often, by acknowledging the ambiguity and attempting to explore symptoms and patient concerns in more detail (HP). Future areas of study could address whether physicians can learn HP behaviors and whether HP behaviors positively affect health outcomes. [ABSTRACT FROM AUTHOR]

Medical family therapy grew out of the experiences of family therapists working with other professionals to provide comprehensive, integrated healthcare for patients (McDaniel, Hepworth, & Doherty, 1992). This is the story of one such patient, her son, and those of us who were the three primary participants on her treatment team. To provide an account that comes closest to the experience itself, we have taken quotes from videotaped sessions and electronic mail communications that occurred throughout the course of therapy. Each provider tells part of the story in his or her own voice. The commentary is provided by Susan McDaniel. [ABSTRACT FROM AUTHOR]

The article focuses on the self-disclosures by primary care physicians. It implies that studies revealed that they are talking about themselves to 25% to 30% of patients and that these act may not be effective in increasing rapport or helping patients engage in improved self-care. On the other hand, it discusses the effectiveness of self-disclosures and offer practical suggestions which focus on verbal self-disclosures and improving them on the basis of several research that were conducted.

BACKGROUND • Underrecognition and undertreatment of mental health disorders in primary care have been associated with poor health outcomes and increased health care costs, but litile is known about the impact of the diagnoses of mental health disorders on health care expenditures or outcomes. Our goal was to examine the relationships between the proportion of mental health diagnoses by primary care physicians and lioth health care expendiaires and the risk of avoidable hospitalizations. METHODS • We used cross-sectional analyses of claims data from an independent practice association-style (IPA) managed care organization in Rochester, New York, in 1995. The sample was made up of the 457 primary care physicians in the IPA and the 243,000 adult patients assigned to their panels. We looked at total expenditures per panel member per year generated by each primary care physician and avoidable hospitalizations among their patients. RESULTS • Alter adjustment for case mix, physicians who recorded a greater proportion of mental health diagnoses generated significantly lower per panel member expenditures. For physicians in die highest quartile of recording mental health diagnoses, expenditures were 9% lower than those of physicians in the lowest quartile (95% confidence interval, 5% - 13%). There was a trend (P = .051) for patients of physicians in the highest quartile of recording mental health diagnoses to be at lower risk for an avoidable hospitalization than those of physicians in the lowest quartile. CONCLUSIONS • Primary care physicians with higher proportions of recorded mental health diagnoses generate significantly lower panel member costs, and their patients may be less likely to be admmited for avoidable hospitalization conditions. [ABSTRACT FROM AUTHOR]