Physician Empathy and Listening

Associations with Patient Satisfaction and Autonomy

Kathryn I. Pollak, PhD; Stewart C. Alexander, PhD; James A. Tulsky, MD; Pauline Lyna, MPH; Cynthia J. Coffman, PhD; Rowena J. Dolor, MD; MHS, Pål Gulbrandsen, MD, PhD; Truls Østbye, MD, PhD


J Am Board Fam Med. 2011;24(6):665-672. 

In This Article

Abstract and Introduction


Purpose: Motivational Interviewing (MI) is used to help patients change their behaviors. We sought to determine if physician use of specific MI techniques increases patient satisfaction with the physician and perceived autonomy.
Methods: We audio-recorded preventive and chronic care encounters between 40 primary care physicians and 320 of their overweight or obese patients. We coded use of MI techniques (eg, empathy, reflective listening). We assessed patient satisfaction and how much the patient felt the physician supported him or her to change. Generalized estimating equation models with logit links were used to examine associations between MI techniques and patient perceived autonomy and satisfaction.
Results: Patients whose physicians were rated as more empathic had higher rates of high satisfaction than patients whose physicians were less empathic (29% vs 11%; P = .004). Patients whose physicians made any reflective statements had higher rates of high autonomy support than those whose physicians did not (46% vs 30%; P = .006).
Conclusions: When physicians used reflective statements, patients were more likely to perceive high autonomy support. When physicians were empathic, patients were more likely to report high satisfaction with the physician. These results suggest that physician training in MI techniques could potentially improve patient perceptions and outcomes.


Patient-physician communication is a central component of high-quality care. Several studies have shown that quality communication is associated with higher patient satisfaction and adherence and a lower probability of malpractice suits.[1–3] Some communication, however, presents challenges for primary care physicians. For instance, physicians report barriers to counseling about weight loss, such as not enough time and fear of embarrassing patients.[4,5] Further, they rarely see positive effects of their counseling.

An effective counseling style that has been receiving attention for application in primary care settings is motivational interviewing (MI). The main purpose of MI is to elicit people's internal motivation to change through exploring and resolving ambivalence.[6,7] When delivered by counselors outside of the primary care encounter, MI has been found to be effective in changing an array of health-related behaviors.[8–11] Three studies have shown that when physicians who are counseling patients use MI techniques, such as reflective statements and praise, their patients are more likely to lose weight.[12,13] By using these MI techniques, physicians partner with patients and show support for their autonomy to make their own changes. This, in turn, may lead patients to feel more satisfied and to believe that they can, in fact, make decisions for themselves.[14,15] However, no one has examined whether these relationships actually occur. In this article, we explore whether physicians' use of MI techniques during weight loss conversations was associated with greater patient satisfaction and perceived autonomy support.


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