Physician Empathy and Listening and Patient Satisfaction

In This Article

Abstract and Introduction
Methods
Results
Discussion
Conclusion
References

Abstract and Introduction

Abstract

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.

Introduction

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.

Cite this: Physician Empathy and Listening - Medscape - Nov 01, 2011.

Table 1. Patient and Visit Characteristics for Patients in Weight-Related Discussions* (n = 320)
Patient characteristics
Baseline weight, kg (mean [SD])	93.9 (21.2)
Obese (BMI ≥30)	61 (194)
Race
White/Asian	61 (196)
African American	39 (124)
Male	34 (108)
Age, years (mean [SD])	58.4 (13.3)
>High school education (missing 1)^†	68 (217)
Economic security: can pay bills easily (missing 11)	88 (272)
Medical history
Diabetes	33 (104)
Hypertension	68 (217)
Hyperlipidemia (missing 1)	56 (180)
Arthritis	43 (136)
Weight loss
Very motivated to lose weight versus somewhat to not at all^‡	58 (184)
Very confident can lose weight versus somewhat to not at all confident^§	36 (115)
Very comfortable discussing weight with physician versus somewhat to not at all^‖	73 (234)
Tried to lose weight during past month	49 (158)
Visit factors (n = 320)
Total patient-medical personnel in-room time, min (mean [SD])	25.9 (10.2)
Total time spent discussing weight, min (mean [SD])	4.2 (3.4)
Who initiated the weight discussion?
Physician	36 (115)
Patient	64 (205)
Weight not discussed	0 (0)
Type of encounter (missing 2)
Preventive	39 (123)
Chronic care	61 (195)
Explicit weight discussion	76 (242)

Values provided as % (n) unless otherwise indicated.
^* Patients were considered "counseled" when physicians used motivational interviewing techniques when discussing weight. ^† Missing data at baseline (counseled sample). ^‡ Motivation to lose weight/address weight (1 = not at all, 7 = very much). ^§ Self-efficacy to lose weight/address weight (1 = not at all confident, 5 = very confident). ^‖ Comfort discussing weight (1 = not at all comfortable, 5 = very comfortable). BMI, body mass index.

Table 2. Patient Characteristics and Satisfaction and Autonomy Support
Patient Characteristics	Total (n)	Excellent Satisfaction	High Perceived Autonomy Support
Weight
Obese (BMI ≥30)	194	11 (22)	36 (69)
Not obese (BMI <30)	126	13 (16)	42 (53)
Race
White/Asian	196	12 (23)	38 (74)
African American	124	12 (15)	39 (48)
Sex
Male	108	8 (9)	32 (35)
Female	212	14 (29)	41 (87)
Age, years* (mean [SD])	320	55.4 (13.1)	59.6 (13.2)
Education (missing 1)
>High School	217	13 (29)	35 (76)
≤High School	102	9 (9)	45 (46)
Economic security (missing 11)
Cannot pay bills easily	37	14 (5)	38 (14)
Can pay bills easily	272	12 (32)	38 (103)
Medical history
Diabetes	104	10 (10)	34 (35)
Hypertension	217	11 (24)	40 (86)
Hyperlipidemia (missing 1)	180	13 (24)	41 (73)
Arthritis	136	11 (15)	43 (59)
Motivated to lose weight
Very motivated	184	15 (27)	42 (77)
Somewhat to not at all	136	8 (11)	33 (45)
Confident can lose weight
Very confident	115	17 (19)	50 (57)
Somewhat to not at all	205	9 (19)	32 (65)
Comfortable discussing weight with physician
Very comfortable	234	15 (35)	44 (104)
Somewhat to not at all	86	4 (3)	21 (18)
Tried to lose weight in past month
Yes	158	11 (17)	42 (66)
No	162	13 (21)	35 (56)

Values provided as % (n) unless otherwise indicated.
^* Mean (SD) for excellent satisfaction and very high perceived autonomy support. BMI, body mass index.

Table 3. Physician Communication and Satisfaction and Perceived Autonomy Support
Model	Total (n)	Excellent satisfaction* (% [95% CI])	Total (n)	High perceived autonomy support^† (% [95% CI])
MI spirit
>1	37	9 (3–23)	36	28 (15–46)
1	283	12 (8–17)	272	37 (30–43)
Empathy
>1	18	27 (14–48)	17	48 (29–68)
1	302	11 (8–15)	291	35 (29–42)
Reflections
Yes	122	9 (5–15)	118	46 (36–57)
No	198	14 (10–20)	190	30 (24–37)
Open questions
Yes	121	10 (5–19)	115	38 (26–50)
No	199	13 (9–19)	193	35 (28–42)
MI behaviors
Any MI adherent	157	11 (7–16)	152	34 (26–42)
No MI adherent	163	13 (8–20)	156	38 (30–47)
Any MI nonadherent	263	11 (7–16)	256	37 (30–44)
No MI nonadherent	57	16 (8–30)	52	31 (21–43)

MI, motivational interviewing.
Bold indicates statistical significance.

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Physician Empathy and Listening

Associations with Patient Satisfaction and Autonomy

Abstract and Introduction

Abstract

Introduction

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

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