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Introduction: Smokers are likely asking their physicians about the safety of e-cigarettes and their potential role as a cessation tool; however, the research literature on this communication is scant. A pilot study of physicians in the United States was conducted to investigate physician–patient communication regarding e-cigarettes. Methods: A total of 158 physicians were recruited from a direct marketing e-mail list and completed a short, web-based survey between January and April 2014. The survey addressed demographics, physician specialty, patient–provider e-cigarette communication, and attitudes towards tobacco harm reduction. Results: Nearly two-thirds (65%) of physicians reported being asked about e-cigarettes by their patients, and almost a third (30%) reported that they have recommended e-cigarettes as a smoking cessation tool. Male physicians were significantly more likely to endorse a harm reduction approach. Discussion: Physician communication about e-cigarettes may shape patients' perceptions about the products. More research is needed to explore the type of information that physicians share with their patients regarding e-cigarettes and harm reduction.

Knowing what patients with irritable bowel syndrome (IBS) want or expect from their medical care is critical in helping them manage the symptoms of this common, chronic gastrointestinal condition. Failure to identify patient expectations can lead to patient dissatisfaction with care, lack of compliance with prescribed treatments, and the inappropriate use of medical resources. Surprisingly little is known about what patients with IBS really want. Several studies suggest that IBS patients value the relational aspects of medical care as highly as technical skills and knowledge. There seems to be a significant communication gap between health care providers and patients regarding IBS care. This article reviews what is known about IBS patients' expectations and needs.

Objective To understand the relationship between eye contact and patient-centered communication (PC) in physician–elder patient interactions. Methods Two instruments—Patient-centered Behavior Coding Instrument (PBCI) and Eurocommunication Global Ratings Scale—were used to measure PC in 22 National Institute of Aging videotapes. Eye contact was measured using a refined eye contact scale in NDEPT. Qualitative observational techniques were used to understand how eye contact can implicate communication. Results ‘High' eye contact tapes were found to be ‘high' in PC using both instruments. However, the majority of ‘low' tapes were also found to be ‘high' in PC. Physicians' behavior distinctly differed in two ways: (1) high tapes were characterized by more ‘sustained' eye contact episodes; low tapes consisted of a greater number of ‘brief' episodes; (2) brief episode tapes showed a greater focus on ‘charts', i.e. ‘listening' was bereft of ‘looking'; sustained episodes showed a focus on ‘patients', i.e. ‘listening' was accompanied by ‘looking' indicating patient-centered communication. Conclusions A comprehensive understanding of elder patient–physician interaction needs to include both—‘listening' and ‘looking'—components of patient-centered communication. Practice implications Eye contact serves as a salient factor in the expression of PC, making it imperative to incorporate as a nonverbal dimension in PC instruments.

To examine whether the effect of health literacy (HL) on patient-physician communication varies with patient-physician language concordance and communication type.771 outpatients rated three types of patient-physician communication: receptive communication (physician to patient); proactive communication (patient to physician); and interactive, bidirectional communication. We assessed HL and language categories including: English-speakers, Spanish-speakers with Spanish-speaking physicians (Spanish-concordant), and Spanish-speakers without Spanish-speaking physicians (Spanish-discordant).Overall, the mean age of participants was 56 years, 58% were women, 53% were English-speakers, 23% Spanish-concordant, 24% Spanish-discordant, and 51% had limited HL. Thirty percent reported poor receptive, 28% poor proactive, and 56% poor interactive communication. In multivariable analyses, limited HL was associated with poor receptive and proactive communication. Spanish-concordance and discordance was associated with poor interactive communication. In stratified analyses, among English-speakers, limited HL was associated with poor receptive and proactive, but not interactive communication. Among Spanish-concordant participants, limited HL was associated with poor proactive and interactive, but not receptive communication. Spanish-discordant participants reported the worst communication for all types, independent of HL.Limited health literacy impedes patient-physician communication, but its effects vary with language concordance and communication type. For language discordant dyads, language barriers may supersede limited HL in impeding interactive communication.Patient-physician communication interventions for diverse populations need to consider HL, language concordance, and communication type.

Use of dietary supplements (DS) is common in the United States; however little is known about the use of DS specifically in hospitalized patients.The goal of this study is to begin to characterize trends in DS use by hospitalized patients and to assess the degree of patient-physician communication about use of DS that occurs during hospitalization.This is a cross-sectional, observational pilot study.Participants were admitted to the general internal medicine or geriatrics service by house staff residents; thoseor= 18 years of age who were medically stable, cognitively intact and fluent in English and/or Spanish were invited to participate in the study.Nearly 80% of hospitalized patients reported use of DS, with 52% reporting use of non-vitamin/non-mineral DS. During the admission process, physicians documented inquiring about DS use only 20% of the time. While the majority of patients had no concern about temporarily discontinuing their DS during hospitalization, 13% of patients reported that they believed there was nothing wrong with continued use of DS while hospitalized regardless of the recommendations provided by their inpatient physicians.Use of DS in hospitalized patients is common, and communication between patients and physicians regarding their use is limited.

The way that we choose how to frame the conversation with parents about halting or continuing such therapy for their children who will not recover has special importance in medicine and in society. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Purpose. To understand and gain insight into improving communication about weight management between patients and physicians and answer the question, “How should physicians communicate with obese patients about weight management?” Design. Three patient focus groups of 5 participants each and 2 physician focus groups of 6 participants each, segregated by gender, during July and August 2004. Participants. Patients with a body mass index of ≥ 30, English speaking, aged 25 to 75 years. Physicians trained in internal medicine or family medicine from a large multispecialty group. Methods. Focus group discussions were transcribed verbatim, a coding scheme developed, and 4 independent reviewers coded each transcript. Consensus among reviewers was obtained. Results. Patients perceive that physicians do not initiate weight discussions, whereas physicians feel that they initiate these conversations regularly. Patients expressed desire for individualized information and advice about weight loss, yet physicians used 1 or 2 messages with all their patients and felt the individualized plans that some patients want are outside the role of the physician. Conclusion. Our results indicate that a communication gap does exist between patients and physicians about weight management. Individualized weight management advice by physicians for patients may reduce this gap.

In clinical practice, a successful patient-physician partnership can improve the outcome of treatment, especially in cases of chronic disease or cancer. To establish this partnership, physicians must explain treatment options and potential outcomes, but how to best do this when treatment is based on scientific principles and findings that the lay patient will not be familiar with? Here we present a paradigm for patient-physician communication using the immunotherapy of cancer as a model. In this context, we argue for the importance of incorporating techniques in communicating science with patients into the training of early career physicians.

We conducted clustering analyses to verify whether common patterns can be identified from two distinct types of end-stage cancer prognosis discussion information, including patient-centered communication and shared decision making data. We applied hierarchical clustering on patient-centered communication measurement data and frequent itemset hierarchical clustering on coded shared decision-making interaction information. Our results suggested modest association between the two data sets in clustering assignments when measuring it with a normalized mutual information index. However, we could not find any noticeable overlap between the two assignments.

This chapter tackles one of the most delicate issues of the Ethical Counselling: communication. Communication is the central skill required for a proper patient–clinician relationship, but it is also vital whenever a service of ethical counselling is implemented. We do not dwell upon how it should be made. Differently, we discuss its neurocognitive counterpart. That is, we show how a wrong way of informing patients about their clinical situation or about the ethical dilemma they are facing could induce dangerous nocebo effects.

Aim: To develop a brief, peer-led communication skills training program for cancer clinicians working in the state of Victoria in response to mounting evidence of the detrimental effects of poor doctor–patient communication. The first workshop module developed by The Cancer Council Victoria for the Victorian Cancer Clinicians Communication Program (VCCCP) focused on delivering bad news to patients and their families. Methods: The workshops consisted of four-and-a-half hour interactive sessions co-facilitated by an oncology clinician and clinical psychologist. Data on the participants' psychosocial beliefs about patient care, confidence and practice behavior were collected via self-administered questionnaires before the workshop and 6 weeks after it. Evaluations on the structure and content of the sessions were collected immediately after the workshop. Results: Data were collected from 11 programs involving a total of 93 cancer clinicians. The results showed a high level of participant satisfaction with the broad aims of the workshop components, in particular the performance of the facilitators and the role-play sessions. Pre- and post-workshop data showed significant improvements over time on items relating to clinician confidence. Despite little change in subjective reports of clinical behavior and beliefs about psychosocial care, most participants reported changes in the way they delivered bad news since attending the VCCCP workshops. Conclusion: The Cancer Council Victoria responded to the needs of cancer clinicians working in the state and established a program that appears acceptable to clinicians who choose to participate.

A philosophical analysis of how physician actions and treatment goals are defined and interpreted and how understanding this process can affect the success of the clinical encounter. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Background A patient’s knowledge of his/her allergic condition and treatment is a key factor in adherence and effectiveness. Methods To assess patients’ understanding of allergy and acceptance of allergen immunotherapy on the basis of (i) information given by their physician at the time of prescription and (ii) a new communication template viewed some months later, we performed an Internet-based survey of patient panels in France, Germany, Spain, the USA and Russia. The survey participants were either recent “early abandoners” (having discontinued allergen immunotherapy before the end of the prescribed course) or “non-starters” (having decided not to initiate a course of allergen immunotherapy recommended by their physician). All participants completed an on-line questionnaire immediately before and immediately after viewing the new communication template. The study’s main objectives were to validate the new communication template and to assess its impact on anticipated willingness to initiate or resume allergen immunotherapy. Results We surveyed a total of 261 patients (France: 57; Germany: 51; Spain: 52; USA: 51; Russia: 50), comprising 127 “early abandoners” and 134 “non-starters”. The mean time since symptom onset and selection for the study was 14.5 years. Subcutaneous allergen immunotherapy had been prescribed in 60 % of cases. Twenty-eight percent of the participants did not know for which allergy they were being treated. Early abandoners reported a perception of low effectiveness (39 %) and complained about expense (39 %) and practical constraints (32 %). Twenty-two percent of the non-starters feared side effects. The communication template was considered to be clear (by 92 % of the patients), convincing (by 75 %) and reassuring (by 89 %); 80 % of the participants felt better informed afterwards, and 67 % stated that viewing the communication template would have made them more likely to continue or initiate allergen immunotherapy (overall willingness score: 5.65 out of 10 before viewing and 7.1 out of 10 afterwards). Conclusions After viewing a new communication template on allergy and allergen immunotherapy, patients participating in the survey felt better informed and more likely to initiate or complete this therapy. It now remains to investigate the communication template’s effect on actual acceptance of and adherence to allergen immunotherapy. Electronic supplementary material The online version of this article (doi:10.1186/s13223-015-0083-z) contains supplementary material, which is available to authorized users.

Low health literacy is a barrier for many patients in the U.S. Patients with low health literacy have poor communication with their physicians, and thus face worse health outcomes. Several government agencies have highlighted strategies for improving and overcoming low health literacy. Mobile phone technology could be leveraged to implement these strategies to improve communication between patients and their physicians. Text messaging, in particular, is a simple and interactive platform that may be ideal for patients with low health literacy. We provide an exemplar for improving patient-physician communication and increasing HIV testing through a text message intervention.

To explore the domain of physician-reported respect for individual patients by investigating the following questions: How variable is physician-reported respect for patients? What patient characteristics are associated with greater physician-reported respect? Do patients accurately perceive levels of physician respect? Are there specific communication behaviors associated with physician-reported respect for patients?We audiotaped 215 patient-physician encounters with 30 different physicians in primary care. After each encounter, the physician rated the level of respect that s/he had for that patient using the following item: "Compared to other patients, I have a great deal of respect for this patient" on a five-point scale between strongly agree and strongly disagree. Patients completed a post-visit questionnaire that included a parallel respect item: "This doctor has a great deal of respect for me." Audiotapes of the patient visits were analyzed using the Roter Interaction Analysis System (RIAS) to characterize communication behaviors. Outcome variables included four physician communication behaviors: information-giving, rapport-building, global affect, and verbal dominance. A linear mixed effects modeling approach that accounts for clustering of patients within physicians was used to compare varying levels of physician-reported respect for patients with physician communication behaviors and patient perceptions of being respected.: Physician-reported respect varied across patients. Physicians strongly agreed that they had a great deal of respect for 73 patients (34%), agreed for 96 patients (45%) and were either neutral or disagreed for 46 patients (21%). Physicians reported higher levels of respect for older patients and for patients they knew well. The level of respect that physicians reported for individual patients was not significantly associated with that patient's gender, race, education, or health status; was not associated with the physician's gender, race, or number of years in practice; and was not associated with race concordance between patient and physician. While 45% of patients overestimated physician respect, 38% reported respect precisely as rated by the physician, and 16% underestimated physician respect (r=0.18, p=0.007). Those who were the least respected by their physician were the least likely to perceive themselves as being highly respected; only 36% of the least respected patients compared to 59% and 61% of the highly and moderately respected patients perceived themselves to be highly respected (p=0.012). Compared with the least-respected patients, physicians were more affectively positive with highly respected patients (p=0.034) and provided more information to highly and moderately respected patients (p=0.018).Physicians' ratings of respect vary across patients and are primarily associated with familiarity rather than sociodemographic characteristics. Patients are able to perceive when they are respected by their physicians, although when they are not accurate, they tend to overestimate physician respect. Physicians who are more respectful towards particular patients provide more information and express more positive affect in visits with those patients.Physician respectful attitudes may be important to target in improving communication with patients.

Physicians can help reduce the large number of patients who do not take their prescription drugs due to the high cost by proactively discussing the topic of drug costs during the clinical encounter and developing a plan for assistance. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Physicians can work with their patients to explore less expensive alternatives for delivering health care if physicians welcome the topic of cost during the clinical encounter. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Relatively few studies have directly addressed the interaction dynamics and consequences of a companion's presence in the medical visit, and their findings have been contradictory.To examine how patient's contribution to the medical dialogue, with or without the presence of a visit companion, is related to the perception of the medical visit as patient-centered.Observational study using pre- and postvisit questionnaires and audiotape recording of medical visits.One hundred and fifty-five patients aged 65 or over; 63 in medical visits that included the presence of a companion and 82 in visits that did not include a companion.Patient ratings of visit patient-centeredness.Long visits (greater than 10 minutes long) and visits in which patients were verbally active were rated as more patient-centered by patients than other visits. Since patients were generally less verbally active in visits that included a companion, accompanied visits, especially if they were less than 10 minutes long, received lower patient-centered ratings than others. The presence of a companion was not related to length of the visit, suggesting that the verbal activity of the companion was off-set by decreased verbal activity of the patient.Our results have suggested that patients are more likely to perceive their physician and visit as patient-centered when they have an opportunity to engage directly in the medical dialogue. A minimal amount of "talk-time" for patients themselves should be safeguarded even in a short visit, when a companion is present.

It is estimated that as many as 80% of adult cancer patients use at least one form of Complementary and Alternative Medicine (CAM) during or after conventional treatment. Studies of physician-patient communication about the use of CAM have concluded that patients frequently do not tell their oncologists about their use of CAM and physicians consistently underestimate the numbers of their patients using CAM. The purpose of this multi-site study was to assess newly diagnosed cancer patients' and oncologists' communication practices with regard to complementary therapies. Patients (106 breast and 82 prostate) indicated which of 45 complementary therapies they were using while physicians at their institutions indicated which they supported. It is noted that, although we use the popular acronym "CAM" all patients surveyed were receiving conventional medical treatment. Thus, the survey addressed complementary therapies only. A large majority (84%) indicated they were using at least one therapy with the most popular being exercise, vitamins, prayer, and nutritional supplements. Surprisingly, the oncologists surveyed were generally enthusiastic and supportive of patients' use of complementary therapies. In addition to those therapies popular with patients, at least half the physicians supported massage, journal writing, support groups, acupuncture, biofeedback, and art therapy. However, discussions of CAM are relatively rare and most likely to be initiated by patients. When the topic is discussed, both patients and doctors say it usually enhances their relationship. Implications for CAM program development and oncology professionals' roles in patient education regarding complementary therapies are presented.

Background. African American women are more likely to be diagnosed at later stages of breast cancer. Methods. A total of 15 residents participated in a program to increase their self-efficacy in communication skills relevant to understanding and responding to African American cultural issues associated with mammography screening. Results. Physicians reported increasing confidence in their ability to elicit barriers to mammography; assess cultural beliefs and norms; assess perceived health benefits and emotional adjustment; engage in emotional talk; motivate; and negotiate and build partnerships with patients. Conclusions. A brief program can increase physician communication skills to meet the needs of a diverse population.

Contemporary oncology practice acknowledges the importance of partnering with the patient and family in dealing with the illness. Patients also value their physicians as important sources of support when they provide information about the illness, encouragement, and hope, discuss treatment options, and address their concerns. For this reason outcomes associated with the quality of the physician-patient relationship have received increasing recognition. This review highlights relevant studies bearing on important outcomes of communication with the cancer patient and discusses the implication for training oncologists of the future.Evidence is mounting that effective and empathic communication with the cancer patient and family can influence desirable outcomes in cancer care, which affect patient quality of life, satisfaction with care, and medical outcomes. Evidence also exists that communication and interpersonal skills can be taught and learned. Oncology training programs traditionally do not offer experience in this aspect of care although communication skills have now been defined as a core competency for oncology trainees. Finding motivated faculty to teach and providing time and structure in the curriculum are also major obstacles to be overcome.Communication skills are the cornerstone of comprehensive cancer care. Learning this aspect of patient care can expand the supportive role of the oncologist especially at crucial times for the patient and family such as diagnosis, disease recurrence, and transition to palliative care.

OBJECTIVE: Physician self-disclosure (PSD) has been alternatively described as a boundary violation or a means to foster trust and rapport with patients. We analyzed a series of physician self-disclosure statements to inform the current controversy.

Resume L’annonce du cancer met a l’epreuve la competence technique et les capacites relationnelles du praticien. Notre objectif etait d’evaluer et de restituer aux praticiens la perception que les patients ont eu de l’annonce du cancer. Un entretien semi-directif evaluant le vecu de l’annonce diagnostique a ete propose a 16 patients en cours de traitement de chimiotherapie pour un cancer colorectal. Chaque entretien etait enregistre, retranscrit puis analyse qualitativement. Les transcriptions etaient restituees aux praticiens et examinees en commun au cours de reunions medico-chirurgicales. Douze patients (6H, 6F), âges de 28 a 74 ans, ont participe. Le lieu de l’entretien etait laisse libre et les patients pouvaient etre accompagnes d’un proche. L’analyse a revele quatre determinants de la qualite relationnelle percue lors de l’annonce du cancer : une connaissance mutuelle patient-praticien prealable a l’annonce, la prise en consideration par le praticien de la place des proches dans le soutien du patient, le respect par le praticien du desir d’information du patient et les modalites d’annonce. Les modalites jugees favorables etaient : un praticien empathique et disponible, une annonce progressive faite en termes clairs, la presence des proches pendant l’annonce si le patient le souhaite, et l’absence de mensonge. La restitution aux praticiens a suscite l’expression de leurs propres difficultes lors de l’annonce et une prise de conscience des attentes des patients. Ce travail confirme qu’une meilleure connaissance de l’experience du patient est utile a une reflexion sur nos pratiques lors de l’annonce du cancer.

Does gender have an influence on the patient-physician communication? Obviously yes is the answer, but this influence may be quite different depending on the specific circumstances in the patient-physician encounter. In this review the starting point are the differences in male and female communication in general. Furthermore the literature regarding the question if female and male physicians communicate differently with their patients will be discussed. Another topic is the question if patients talk differently to male and female physicians and if men and women communicate differently with their physician. Recently the question if female and male patients get different diagnostic and therapeutic procedures has gained much interest. There are few data answering the question if gender dyads (e.g. female patient-female doctor) have specific communication patterns. Very little is known about how being gay or lesbian influences patient-physician communication.

Purpose of review Patient-physician communication is a vital element of the process of care. In numerous studies, communication behaviors during the medical interaction have been significantly associated with a variety of patient satisfaction and health outcomes. The purpose of this review is to synthesize recent findings in the area of patient-physician communication, particularly as they relate to patients with rheumatic disease. Recent findings Although there is scant research on the medical interaction with patients with rheumatic disease specifically, there is a large body of literature examining patient-doctor communication in other chronic diseases. Because many of the findings of studies conducted in patients with other diseases can be extended to patients with rheumatic disease, this review also covers the most salient literature published in the past year on patient-doctor communication in chronic diseases in general, in addition to covering publications in the field of rheumatology. Summary The literature reviewed shows that patients' expectations of medical encounters are not always fulfilled and that patients desire increased participation and information sharing. Establishing patient-centered care is a challenging goal, but fortunately, recent studies show that physicians can be trained, irrespective of the years in practice, to provide patient-centered care and increase patient participation and satisfaction with care.

While patients frequently do not comprehend health information, little is known about patient and physician factors that influence lack of comprehension. To assess effectiveness of health information exchange, 19 physicians and 145 patients were given post-encounter questionnaires to evaluate the preceding visit. We analyzed differences in beliefs between patients who comprehended health information and patients who did not, and whether physicians' attitudes and self-assessment of their educational abilities influenced this comprehension. Patients with insufficient comprehension were more likely to have schooling below college and cited language as a barrier. Physicians who believed health information delivery to be important had fewer patients with comprehension difficulties, while physicians who assessed themselves as very effective educators had significantly more patients with lack of comprehension, compared with physicians who did not feel as effective. Patients' comprehension of health information was associated not only with patient factors but also with physicians' attitude and self-assessment.

Inspired in part by psychologists’ concept of goal attainment scaling nearly 50 years ago, this chapter describes a practical, patient-centered, goal-oriented model of geriatric medical care. This customized care approach requires clinicians to be aware of and able to set aside their own, personal preferences and values in order to more actively attend to those of their patients, many of whom live with multimorbidity. Benefits and barriers to implementing this paradigm shift from disease to patient focus are addressed, and possible solutions are offered.

64 Background: Clinical management of patients with advanced cancer is complex, involving specialized treatment and multiple healthcare providers in different settings. In this context, care coordination and sharing of contextual information is often inadequate, leading to suboptimal continuity of care. Electronic communication has the potential to address these gaps and engage patients in their own care. We studied a web-based tool which assembles the patient, their caregivers and their healthcare providers in a virtual space for team-based communication. We sought to understand participant perceptions on electronic communication in general, and the added value of the new tool in particular. Methods: We conducted a qualitative descriptive study with participants (patients with advanced cancer, caregivers, cancer physicians) who participated in a 3-month pilot trial evaluating the tool. Interviews were thematically analyzed and the perspectives from patients, caregivers and cancer physicians were triangulated. Results: We identified five themes relating participants’ perspectives on electronic communication to their experience of care: 1) apparent gaps in care; 2) uncertainty in defining the circle of care; 3) relational aspects of communication; 4) incongruence between technology and social norms of patient-physician communication; and 5) appreciation but apprehension about the role of the electronic communication tool for improving the experience of care. Conclusions: The potential of tools for electronic communication to bring together a team of healthcare providers with the patient and caregivers is significant but may pose new challenges to existing team structure and interpersonal dynamics. Patients and physicians were worried about the impact that electronic communication may have on the patient-physician relationship. Implementation approaches which build on the relationship, and integrate the team as a whole, could positively position electronic communication to enhance team-based care.

Objectives This study evaluated how physicians and patients perceive the impact of computer use on clinical communication, and how a patient-centered orientation can influence this impact. Methods The study followed a descriptive cross-sectional design and included 106 family physicians and 392 patients. An original questionnaire assessed computer use, participants’ perspective of its impact, and patient centered strategies. Results Physicians reported spending 42% of consultation time in contact with the computer. A negative impact of computer in patient–physician communication regarding the consultation length, confidentiality, maintaining eye contact, active listening to the patient, and ability to understand the patient was reported by physicians, while patients reported a positive effect for all the items. Physicians considered that the usual computer placement in their consultation room was significantly unfavorable to patient–physician communication. Conclusions Physicians perceive the impact of computer use on patient-physician communication as negative, while patients have a positive perception of computer use on patient-physician communication. Practice implications Consultation support can represent a challenge to physicians who recognize its negative impact in patient centered orientation. Medical education programs aiming to enhance specific communication skills and to better integrate computer use in primary care settings are needed.

Objective: To determine the new roles that physicians will adopt in the near future to adjust to accelerating trends from managed care to outcome-based practice to health care reform to health information technology to the evolving role of health consumers.Methods: Trends and related developments concerning the changing roles of physicians based on prior literature reviews.Results: Six possible roles, traditional, gatekeeper, coach, navigator, informatician and one voice among many, are discussed in terms of physician's centrality, patient autonomy, decision-making and uncertainty, information seeking, satisfaction and outcomes, particularly those related to compliance.Conclusion: A greater understanding of these emerging roles could lead to more efficacious outcomes in our ever changing, increasingly complex medical system. Patients often have little understanding of emerging trends that lead to the development of specialized roles such as hospitalist and navigators and, relatedly, the evolving roles of ...

Optimal patient-physician communication is integral component in the rendering of medical care. Despite the importance of adequate communication, substantial barriers including time constraints, inadequate provider expertise and variation among patients in their ability to provide complete history of illness, exist which do not allow a comprehensive clinical evaluation at the patient's bedside. As governments and the public scrutinize healthcare costs and quality, it is imperative that we develop tools such as speech recognition based support systems that will assist the provider in obtaining a complete history and physical examination. Here we propose a mobile healthcare assistant system, Appurtenant, aiming at improving completeness and efficiency of bidirectional patient-physician communication for less experienced clinicians without interruption and reducing costs of care by ensuring a standardized approach to patient evaluation.

Objective We aimed to demonstrate how a novel analytic strategy – the one-with-many (OWM) design – can provide unique information about patient–physician communication that cannot be obtained using traditional analytic strategies. Methods Using an OWM design we conducted a secondary analysis of behavioral (talk time) and self-reported (perceived teamness) data from a study of patient–physician communication, and examined variance decompositions of these variables. Results Talk time was largely relational, suggesting that there is no behavioral consistency on the part of physicians across patients or behavioral similarity among patients who see the same physician. In contrast, there was significant actor variance in perceived teamness, suggesting that some physicians consistently reported higher teamness with their patients than others. However, those physicians’ positive perceptions of the communication are not necessarily reciprocated by their patients. Conclusions OWM design provides researchers with the opportunity to take full advantage of rich non-independent data and explore interesting communication patterns (e.g., behavioral continuity, similarity, reciprocity unique to specific dyads) that have been omitted in prior literature. Practical implications OWM can be used to determine the relative differences in how patients and physicians influence communication patterns and identify which aspects of physician–patient communication are relational and which are not.

OBJECTIVE: To evaluate prospectively seriously ill patients' characteristics, perceptions, and preferences associated with discussing resuscitation (CPR) with their physicians. DESIGN: Prospective cohort. SETTING: Five academic medical centers. PARTICIPANTS: Patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments who had not communicated with their physicians about CPR at admission to a hospital for life-threatening illness (n = 1288). MEASUREMENTS: Baseline surveys of patients' characteristics, health status, desires for participation in medical decision making, and cardiopulmonary resuscitation. Two month follow-up surveys of patients' communication of resuscitation preference. Chart reviews for clinical indicators. RESULTS: Thirty percent of patients communicated their resuscitation preference to their physician during a 2 month-period following hospital admission. Patients whose preference was to forgo CPR (odds ratio (OR) 2.9; (95% CI, 1.9-4.2)) and whose preference had changed from desiring to forgoing CPR (OR 1.6; (95% CI, 1.1–2.4)) were more likely to communicate their preference than patients who continued to prefer to receive CPR. However, only 50% of patients who maintained a preference to forgo CPR communicated this over a 2-month period. Having an advance directive and remaining in the hospital at 2-month follow-up were also independently associated with communication, whereas patients' preference for participation in decision-making, health status, and prognostic estimate were not. CONCLUSIONS: Communication about resuscitation preferences occurred infrequently after hospital admission for a serious illness, even among patients wishing to forgo resuscitation. Factors such as declining quality of life, which were expected to be associated with communication, were not. An invitation to communicate about CPR preference is important after hospital admission for a serious illness. Novel approaches are needed to promote physician-patient discussions about resuscitation.

Effective patient-physician communication significantly influences health outcomes of older patients. For example, concordance between patient and physician expectations and patient participation in the decision-making process affects older patients. Communication is also linked to patient recall, adherence, and satisfaction. Furthermore, communication impacts emotional and physical outcomes of older patients, although evidence of improved physical outcomes remains under-investigated in this population. Dimensions of communication, such as continuity of relationship, seem to be important in decreasing hospitalization of older patients. This article explores the link between communication and health care outcomes in the older population.

Physicians should counsel overweight adolescents about nutrition and exercise. We audio recorded 30 physician–adolescent encounters. Female, older, normal-weight physicians and pediatricians were more Motivational Interviewing (MI) adherent. When physicians used MI skills, patients increased exercise, lost weight, and reduced screen time. Physicians should use MI techniques to help adolescents change.

This paper provides a comprehensive review and comparison of instruments used to assess patient-doctor interaction over the past decade. Instruments were identified from papers indexed by MEDLINE from 1986 to 1996 using the medical subject headings `physician-patient relations', `physician-patient communication', and `education, medical', as well as requests for instruments currently in use by colleagues. Each instrument was reviewed under the following categories: name of the instrument; description; number of items; reliability; validity; current use and special notes. Overall, 44 instruments were obtained and reviewed. Of these, 21 were used in only one published study each in the last decade and 15 have never been validated. While most instruments have been shown to be reliable (usually inter-rater reliability), very few instruments have been directly compared with another instrument designed to assess patient-doctor interactions. We suggest that further validation of existing instruments and incorporation of assessment of non-verbal communication between the patient and the doctor are needed.

The purpose of this study was to assess patient perceptions of physician competence, listening behavior and patient-centered communication using allopathic and naturopathic physicians. Results demonstrated the naturopathic physician was perceived as a more empathic listener than the allopathic physician. Naturopathic and allopathic physicians did not differ on technical communication competence. Patients believed that both types of physicians could be more patient-centered and more empathic with them. The ideal communication behavior was statistically different from the actual behavior on all measures.

A physician outlines strategies to help reduce a patient's out-of-pocket prescription drug expenses. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Objective: To determine whether elderly patients with complex drug regimens have enough information to ensure safe drug use. Methods: A cross-sectional study was conducted in Spain based on interviews of a random sample of 265 patients aged over 65 and taking at least five drugs for multiple comorbidities. General practitioners reported on diagnoses, drugs, dosage and biochemical laboratory results. Patients were asked about the medications they were taking (with higher scores indicating greater knowledge). Results: The patients took an average of 7.9 medications (SD 3.0). The mean scores were low for precautions (mean 0.3, SD 0.7) and how to properly store medications (mean 2.0, SD 3.0). Scores were significantly higher when physicians regularly provided patients with information (F-test 3.3, p = 0.039) and were not related to gender, years of treatment or health status. Frequent changes in medication adversely affected the scores (p = 0.03). Higher scores were related to a smaller number of medication errors (t-test 2.2, p = 0.032, CI 95% of the difference 0.6 - 1.2). Conclusions: Older complex chronic patients are unaware of the precautions they must adopt to use their medications safely. Patient knowledge does contribute to reducing medication errors. When physicians change prescriptions, modify doses or introduce new medications, more information needs to be provided for safe use of the drugs.

When given a choice, how do people decide which physician to select? Although significant research has demonstrated that how people actually feel (their “actual affect”) influences their health care preferences, how people ideally want to feel (their “ideal affect”) may play an even greater role. Specifically, we predicted that people trust physicians whose affective characteristics match their ideal affect, which leads people to prefer those physicians more. Consistent with this prediction, the more participants wanted to feel high arousal positive states on average ([ideal HAP]; e.g., excited), the more likely they were to select a HAP-focused physician. Similarly, the more people wanted to feel low arousal positive states on average ([ideal LAP]; e.g., calm), the more likely they were to select a LAP-focused physician. Also as predicted, these links were mediated by perceived physician trustworthiness. Notably, while participants’ ideal affect predicted physician preference, actual affect (how much people actually felt HAP and LAP on average) did not. These findings suggest that people base even serious decisions on how they want to feel and highlight the importance of considering ideal affect in models of decision making, person perception, and patient physician communication.