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Effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart and art of medicine. This is important in the delivery of high-quality health care. Much patient dissatisfaction and many complaints are due to breakdown in the doctor-patient relationship. However, many doctors tend to overestimate their ability in communication. Over the years, much has been published in the literature on this important topic. We review the literature on doctor-patient communication.

Doctor-patient communication: a review.

When patients and physicians are of the same race, patients are more satisfied with care in the office setting. The authors found that having the same race did not affect patient-centered communica...

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Patient-Centered Communication, Ratings of Care, and Concordance of Patient and Physician Race

BACKGROUND: The Institute of Medicine calls for physicians to engage patients in making clinical decisions, but not every patient may want the same level of participation. OBJECTIVES: 1) To assess public preferences for participation in decision making in a representative sample of the U.S. population. 2) To understand how demographic variables and health status influence people’s preferences for participation in decision making. DESIGN AND PARTICIPANTS: A population-based survey of a fully representative sample of English-speaking adults was conducted in concert with the 2002 General Social Survey (N=2,765). Respondents expressed preferences ranging from patient-directed to physician-directed styles on each of 3 aspects of decision making (seeking information, discussing options, making the final decision). Logistic regression was used to assess the relationships of demographic variables and health status to preferences. MAIN RESULTS: Nearly all respondents (96%) preferred to be offered choices and to be asked their opinions. In contrast, half of the respondents (52%) preferred to leave final decisions to their physicians and 44% preferred to rely on physicians for medical knowledge rather than seeking out information themselves. Women, more educated, and healthier people were more likely to prefer an active role in decision making. African-American and Hispanic respondents were more likely to prefer that physicians make the decisions. Preferences for an active role increased with age up to 45 years, but then declined. CONCLUSION: This population-based study demonstrates that people vary substantially in their preferences for participation in decision making. Physicians and health care organizations should not assume that patients wish to participate in clinical decision making, but must assess individual patient preferences and tailor care accordingly.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1525-1497.2005.04101.x

Not all patients want to participate in decision making. A national study of public preferences.

Social role theory.

ContextPhysician gender has been viewed as a possible source of variation in
the interpersonal aspects of medical practice, with speculation that female
physicians facilitate more open and equal exchange and a different therapeutic
milieu from that of male physicians. However, studies in this area are generally
based on small samples, with conflicting results.ObjectiveTo systematically review and quantify the effect of physician gender
on communication during medical visits.Data SourcesOnline database searches of English-language abstracts for the years
1967 to 2001 (MEDLINE, AIDSLINE, PsycINFO, and Bioethics); a hand search was
conducted of reprint files and the reference sections of review articles and
other publications.Study SelectionStudies using a communication data source, such as audiotape, videotape,
or direct observation, and large national or regional studies in which physician
report was used to establish length of visit, were identified through bibliographic
and computerized searches. Twenty-three observational studies and 3 large
physician-report studies reported in 29 publications met inclusion criteria
and were rated.Data ExtractionThe Cohen d was computed based on 2 reviewers'
(J.A.H. and Y.A.) independent extraction of quantitative information from
the publications. Study heterogeneity was tested using Q statistics and pooled
effect sizes were computed using the appropriate effects model. The characteristics
of the study populations were also extracted.Data SynthesisFemale physicians engage in significantly more active partnership behaviors,
positive talk, psychosocial counseling, psychosocial question asking, and
emotionally focused talk. There were no gender differences evident in the
amount, quality, or manner of biomedical information giving or social conversation.
Medical visits with female physicians are, on average, 2 minutes (10%) longer
than those with male physicians. Obstetrics and gynecology may present a different
pattern than that of primary care, with male physicians demonstrating higher
levels of emotionally focused talk than their female colleagues.ConclusionsFemale primary care physicians engage in more
communication that can be considered patient centered and have longer
visits than their male colleagues. Limited studies exist outside of
primary care, and gender-related practice patterns in some
subspecialties may differ from those evident in primary
care.

https://jamanetwork.com/journals/jama/articlepdf/195191/jrp10033.pdf

Physician gender effects in medical communication: A meta-analytic review

ContextHepatitis C is the leading cause of chronic liver disease in the United
States. Several trials have found that interferon and ribavirin combination
therapy is more efficacious than interferon monotherapy for previously untreated
patients and those who relapsed after prior interferon monotherapy, but its
effectiveness for nonresponders to prior interferon monotherapy is unclear.ObjectiveTo assess the efficacy and safety of interferon and ribavirin vs interferon
alone for treatment of patients with chronic hepatitis C who previously did
not respond to interferon monotherapy.Data SourcesA systematic search was performed using MEDLINE and the Science Citation
Index for publications from 1966 to December 1999. A manual reference search
and a manual review of relevant specialty journals also were performed, and
input from clinical hepatology experts was sought.Study SelectionIncluded studies were randomized, controlled clinical trials comparing
interferon and ribavirin with interferon alone and reporting virological and
biochemical outcomes after a follow-up period. Of 50 identified studies, 12
trials (941 patients) were included in the analysis.Data ExtractionTwo investigators reviewed trials independently for methods, inclusion
and exclusion criteria, and outcomes. Disagreements were resolved by discussion.
Abstracted data included study and patient characteristics and virological,
biochemical, and histological outcomes. A quality evaluation questionnaire
was used to score studies.Data SynthesisThe pooled virological response rate for combination therapy was 14%
(95% confidence interval [CI], 11%-17%), with a risk difference favoring combination
therapy of 7% (95% CI, 2%-13%). Use of interferon alfa-2a/2b and ribavirin,
1000 to 1200 mg/d, was associated with a pooled virological response rate
of 18% and a risk difference of 16% (95% CI, 11%-21%). When interferon alfa-n/n3
and a lower dosage of ribavirin (600-800 mg/d) were used, the risk difference
was 0% (95% CI, –7% to 7%). Combination therapy was associated with
more adverse effects and an increased rate of discontinuation of treatment
compared with interferon monotherapy.ConclusionsFor chronic hepatitis C that is nonresponsive to prior interferon monotherapy,
combination therapy is more effective than re-treatment with interferon alone.
Response rates remain less than 20% even in the most responsive subgroups,
demonstrating a need for better therapeutic options.

Interferon and ribavirin vs interferon alone in the re-treatment of chronic hepatitis C previously nonresponsive to interferon: A meta-analysis of randomized trials.

Yutaka Aoki

Papers

Physician gender effects in medical communication: A meta-analytic review

Interferon and ribavirin vs interferon alone in the re-treatment of chronic hepatitis C previously nonresponsive to interferon: A meta-analysis of randomized trials.

Physician Gender Effects in Medical Communication