Wanzer et al: Preceptions of health care providers' communication

Question 1

What is the theme of the piece?

Answer 1

Seeking and Providing Information

Question 2

What is provider-centered communication?

Answer 2

1980s, researchers began to document and challenge patterns of physician dominance in physician-patient interaction.
Why?
- Sociological, cultural, psychological and communicative

Question 3

Why do we have this dominance?

Answer 3

• *Sociological: hierarchy, job security

* *cultural explanations: society views

Question 4

When did they see provide-patient communication

Answer 4

Early evidence of physician-centered communication (1980s)

Patient’s ask between 1% (Frankel) and 10% (West) of all questions during a medical encournter

Question 5

What does this method suggest?

Answer 5

Suggestions interrogation not conversation:

• Questions and power:
  1. Selection/timing of next speaker
  2. Topical control
  3. Right to speak again after an answer

Question 6

True or False.

Question format does not make a difference.

Answer 6

FALSE.

Question Format makes a BIG difference

Question 7

What type of questions are there?

Answer 7

Open-ended vs. closed ended

Question 8

What are some examples

Answer 8

“Tell me more about your stomach pain.”
“when do you get this pain? Is it more of an ache or a sharp pain? Does it get worse when you eat? Are you having regular bowel movements? Are you having any headaches with this?
“The process of differential diagnosis sometimes requires closed-ended questions”

Question 9

Why do we do this?

Answer 9

Allows the patient to explain to you what is really going on where the provider is able to gain insight on this.

Question 10

What is differential diagnosis?

Answer 10

Interactive Q&A sequence. There is a purpose for closed questions

Question 11

What are embedded presuppositions?

Answer 11

“Still taking the lithium as prescribed?”
“Can you tell me about how you take your lithium?”
“How’s everything going with the Lithium?”

Question 12

What are direct vs. Indirect questions?

Answer 12

“Can you explain how cholesterol works?”
“I saw this commercial about knowing your cholesterol level and I was like ‘I can’t even spell cholesterol”
“My daughter has been nagging me all week to ask about my cholesterol today”
“Providers must be able and willing to hear the question inside these indirect formulations”

Question 13

What is the data for the number of questions male and female patients ask a male physician?

Answer 13

Male Physician asks about 74% of all Questions
Male Patient: asks 3.7 questions per visit
Female Patient asks 8 questions per visit

Question 14

What is the data for the number of questions male and female patients ask a female physician?

Answer 14

Female Physician: asked 50% of questions
Male patients: 10.9 questions per visit
Female patients: 10.8 questions per visit

Question 15

What does the data mean?

Answer 15

Male physicians ask more questions than female physicians.

Patient’s are more willing and comfortable speaking with a female since males can be more dominating.

Question 16

What’s the primary reason for asking questions?

Answer 16

To get information

Question 17

What else does the data say?

Answer 17

Male and female patients ask more questions when with a female physician as well as about the same number of questions.
With a male physician less questions females > males

Question 18

What are the basic factors included in PCC?

PCC: Patient-Centered Communication

Answer 18

• *Attending to both medical and emotional needs
• • understanding patients’ reasons for the visit
• *Understanding patients’ life circumstances
• • Increasing prevention and promoting health initiatives
• *Enhancing the provider patient relationship

Question 19

What are the benefits to PCC?

Answer 19

• Better health outcomes
• Better treatment adherence
• Higher Satisfaction
• Less satisfaction
• Less anxiety and discomfort
• Fewer diagnostic tests
• Fewer return visits

Question 20

What is the Study?

Answer 20

Main purpose is to look fo relationships between PCC behaviors and patient satisfaction

Behaviors: Patient satisfaction with communication and patient satisfaction with medical care

Question 21

What are the communicative behaviors?

Answer 21

1. Introductions
2. Clarity
3. Empathy
4. Immediacy
5. Listening
6. Humor

Question 22

What are the methods in the study?

Answer 22

*Setting: large eastern children’s hospital
*Participants: 195 parents (74% women; mean age 33), 50% serious illnesses, 50% non-serious (length of stay)
*Instruments: survey of perceived PCC behaviors among physicians, nurses and staff
survey of statisfaction with communication and medical care

Question 23

What is H1 (a) (b) (c)

Answer 23

All supported

Higher physician, nurse, and staff PCC behaviors associated with higher satisfaction with communication

Question 24

What is H2 (a) (b)

Answer 24

Both supported

Higher physician and nurse PCC behaviors associated with higher satisfaction with medical care

Question 25

What is RQ1 (a) (b) (c)

Answer 25

A) physicians: immediacy, listening, empathy
B) nurses: empathy
C) Staff: immediacy, clarity
these were the PCC behaviors that parents rated as having the most influence on satisfaction with communication

Question 26

What is RQ2 (A) (B)

Answer 26

A) physicians: clarity, listening
B) nurses: introductions, listening
These were the PCC behaviors that parents rated as having the most influence on satisfaction with medical care

Question 27

What is RQ4 (a) (b) (c)* (presented out of order)

Answer 27

Parents of more seriously ill children reported that physicians nurses ans staff engaged in fewer PCC behaviors than parents of less seriously ill children

Question 28

What is RQ3 (a) (b)?

Answer 28

(a) Parents of more seriously ill children were less satisfied with communication than parents of less seriously ill children.
(b) Parents of more seriously ill children were less satisfied with medical care than parents of less seriously ill children.

Question 29

What is an aspect of PCC that didn’t seem to have much influence?

Answer 29

Humor