When physicians and patients think alike: patient-centered beliefs and their impact on satisfaction and trust - Original Research

Journal of Family Practice, Dec, 2001 by Edward Krupat, Robert A. Bell, Richard L. Kravitz, David Thom, Rahman Azari

KEY POINTS FOR CLINICIANS

* Patients who want to share power and control with their physicians are more likely to be female, white, younger, and of higher education and income. Among physicians, however, neither age nor sex were related to the same beliefs about sharing.

* When physicians and patients hold similar beliefs, patients are more likely to endorse and trust their physicians.

* Patients' trust and endorsement of their physicians may come as much from a meeting of the minds as it does from specific beliefs or practices of the physician.

* OBJECTIVE Our goal was to identify physician and patient characteristics associated with patient-centered beliefs about the sharing of information and power, and to determine how these beliefs affect patients' evaluations.

* STUDY DESIGN Physicians provided demographic information and completed a scale assessing their beliefs about sharing information and power with their patients. A sample of their patients filled out the same scale and made evaluations of their physicians before and after a target visit.

* POPULATION Physicians and patients in a large multispecialty group practice and a model health maintenance organization were included. Forty-five physicians in internal medicine, family practice, and cardiology participated, as well as 909 of their patients who had a significant concern.

* OUTCOMES MEASURED We measured trust in the physician pre-visit, and visit satisfaction and physician endorsement immediately post-visit.

* RESULTS Among patients, patient-centered beliefs (a preference for information and control) were associated with being female, white, younger, more educated, and having a higher income; among physicians these beliefs were unrelated to sex, ethnicity, or experience. The patients of patient-centered physicians were no more trusting or endorsing of their physicians, and they were not more satisfied with the target visit. However, patients whose beliefs were congruent with their physicians' beliefs were more likely to trust and endorse them, even though they were not more satisfied with the target visit.

* CONCLUSIONS The extent of congruence between physicians' and patients' beliefs plays an important role in determining how patients evaluate their physicians, although satisfaction with a specific visit and overall trust may be determined differently.

* KEYWORDS : Physician-patient relations; patient-centered care; congruence [non-MESH]; patient satisfaction; trust [non-MESH]. (J Fam Pract 2001; 50: 1057-1062)

A Patient-centered approach to care has been widely advocated (1-5) Although there are several dimensions to patient-centeredness, one key element involves patient participation and the sharing of power and information between the patient and physician. Physicians who take a patient-centered orientation approach are more likely to treat them as partners, and assist them in making informed choices among several options. This approach has been associated with a range of positive outcomes, such as heightened patient satisfaction, better adherence, and improved health outcomes. (6-10)

Yet in spite of the general effectiveness of patient-centeredness, it is reasonable to ask whether a one-size-fits-all approach to patient care is the best one. Some patients -- such as the elderly, or patients of certain ethnic backgrounds, for example -- may desire a physician whose style is more structured and who provides more guidance. (11-14) Patients who are sick or have serious health concerns may also want their physicians to provide more direction. (15,16) Therefore, while accepting the overall value of patient-centeredness, some physicians and researchers have advocated that the degree of "fit" between patients and physicians, (the extent to which the physician holds attitudes and beliefs that are congruent with those of the patient (17,21)) should have an independent effect upon patients' reactions to their health care providers.

Our study involves the measurement of patient-centeredness among both physicians and patients, in particular beliefs about the sharing of power and information. We asked what personal characteristics were associated with patient-centered beliefs among physicians and patients, and investigated the extent to which patients felt positively about clinicians who hold matching opinions about power and information sharing.

METHODS

The data we report come from the Physician Patient Communication Project, a large observational study conducted in the Sacramento, California, metropolitan area. Patients in the study were surveyed before and immediately after a target outpatient visit. The physicians provided data before and immediately after the same visits.

Physician Sampling and Data Collection

All physicians and patients in the study were affiliated with one of the 2 major health care systems in the region, the University of California, Davis, Medical Group (UCDMG) or Kaiser Permanente (KP). All physicians were involved in direct patient care at least 20 hours per week in family medicine, internal medicine, or cardiology. Forty-five physicians took part in the study (22 from UCDMG, 23 from KP). Eighteen practiced general internal medicine; 16 were family physicians; and 11 were cardiologists. The UCDMG and KP physicians did not differ significantly with regard to age or sex.