Impact of Doctor's Interpersonal Communication Skill on Patient's Satisfaction Level

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ORIGINALARTICLE ISRA MEDICAL JOURNAL | Volume 10 - Issue 5 | Sep–Oct 2018
306
Impact of Doctor’s Interpersonal Communication Skill on
Patient’s Satisfaction Level
Fahad Tanveer1, Sana Shahid2, Muhammad Mansoor Hafeez2
ABSTRACT
OBJECTIVE:To assess the impact of interpersonal communication skills of a doctor on level of satisfaction of a patient.
STUDY DESIGN: A cross sectional observational study.
PLACE AND DURATION: Services Hospital Lahore, Jinnah Hospital Lahore, GHQ D.G Khan, Nishtar Hospital Multan, CMH Wah Cantt,
Punjab Medical Center, Rasheed Hospital Lahore. This study was completed in 6 months from 1st January 2017 to 30th June 2017
METHODOLOGY: Kalamazoo Essential Element Communication Checklist tool was used for assessing the communication ofdoctor
and patient satisfaction questionnaire tool was used to measure the level of satisfaction of patients.
RESULT:The mean value for Kalamazoo essential element communication checklist (KEECC) was (Mean ± SD=14.9±5.6). The mean
value for patient satisfaction questionnaire (PSQ) was (Mean ± SD=19.2±1.9). Communication of doctor and patient satisfaction level
shows statistically significant but weak correlation (r=0.258 and p <0.05)
CONCLUSION: Interpersonal communication skills of doctor have a strong impact on patient satisfaction level.
KEY WORDS: Doctor, Patients, Satisfaction Level, Interpersonal, Communication Skills, Impact
HOW TO CITE THIS:
Tanveer F, Shahid S, Hafeez MM. Impact of Doctor’s Interpersonal Communication Skill on Patient’s Satisfaction Level. Isra Med J.
2018; 10(5): 306-309.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 4.0 International License
(http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
INTRODUCTION
Interpersonal skill is the ability to communicate or interact well
with other people. A communication skill of a doctor is a key
element of patient experience. Studies related to
communication skills and its impact on patient satisfaction
have not been conducted.1The relationship between doctor
and patient is the center piece and it has also a significant
effect on treatment outcomes and level of patient
satisfaction.2 Good doctor/therapist must have effective
communication skills as it is part of their practice.3 Practical
and concept base framework are there that will enhance the
physician-patient communication to the professional level of
competence.3 Because the good communication of clinician
results in enhanced patient’s adherence and it also increases
physical and psychological outcomes of the patient.4
In the case of impeded or poor communication between
patient and clinician, it may negatively affect the treatment
process and also leads to serious events.5Adherence, self-
efficacy, social support, and understanding are the maximized
therapeutic effect of communication between clinician and
patient and all of these are linked with better health
outcomes.6So the communication between clinician and
patient can predict the outcomes of treatment after
consultation.6Shared decision-making and treatment have
improved impact on patient adherence and clinical
outcomes.7 and because of this communication barrier, most
of the patient complaints that often the times the clinician do
not have any interest in their concerns, their problems and
they also do not provide sufficient information about their
problem.8
The clinician who has negative behavior towards
1. Assistant Professor
2. Senior Lecturer
Department of Physical Therapy
University Institute of Physical Therapy, University of
Lahore
Correspondence to:
Fahad Tanveer
Assistant Professorof Physical Therapy
University Institute of Physical Therapy
University of Lahore
Email: fahadtanveer3.pt@gmail.com
Received for Publication: 27-08-17
1st Revision of Manuscript: 09-11-17
2ndRevision of Manuscript: 23-01-18
3rd Revision of Manuscript: 14-02-18
4th Revision of Manuscript: 27-02-18
5th Revision of Manuscript: 15-03-18
Accepted for Publication: 06-04-18

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communication has more chances of dereliction of duty as
compared to the clinician with positive behavior towards
communication.9In context to Pakistan, the area of research is
highly underdeveloped in health care units. As there is very
limited data on the communication of doctor, so this study will
add up literature to effective communication and its effects in
health care settings. Results of this research will have potential
benefits to find deficits and to apply the communication
strategies to enhance patient adherence level, reduces their
complaints and increase their level of satisfaction and will
provide a better quality treatment and improved
communication of health care provider and the doctor-patient
relationship. The objective of the study was to assess the
impact of interpersonal communication skills of a doctor on
level of satisfaction of a patient.
METHODOLOGY
This cross-sectional observational study was done through
convenient sampling technique. Data of 178 respondents were
collected from various hospitals of the Punjab i.e. Services
Hospital Lahore, Jinnah Hospital Lahore, GHQ D.G Khan,
Nishtar Hospital Multan, CMH Wah Cantt, Punjab medical
center, Rasheed hospital Lahore from 1st January 2017 to 30th
June 2017. The online Rao soft was used to calculate the
sample size. Patients from both government and private
setups, stressed patient, patients having treatment of more
than 2 weeks, age less than 50 years were included in the
study. Patient with hearing problems, neurological disable
patient, cognitive impairment, acute injury were excluded.
Convenient sampling along with Kalamazoo Essential Elements
Communication Checklist (KEECC)2 and Patient Satisfaction
Questionnaire (PSQ)9 was used Data was collected from
patients with age<50 years including adults, children and
elders and then effects of communication on patient
satisfaction level were found.
Data Analysis: Data was analyzed by using IBM SPSS Statistics
version 21; categorical variables were presented in the form of
frequency tables and discrete variables presented in the form
of mean and standard deviation. Frequency, Mean and
standard deviation was calculated for variables of Kalamazoo
essential element communication checklist and components of
patient satisfaction questionnaire and Pearson correlation
were used to measure the correlation between communication
skills and patient satisfaction level.
RESULTS
A total of 178 patients were assessed. Highest average score
for the variable of PSQ goes for communication, financial
aspect and time spent with doctor with 2.9 score while lowest
score goes for accessibility and convenience with 2.4 score.
(Table-I) The mean value of Patient satisfaction questionnaire
was 19.2±1.9 and Kalamazoo essential element communication
checklist (KEECC) was 14.9±5.6 Table II On KEECC scale, out of
178 patients, 76 rated building relationship as very good, 86
rated opens discussion as very good, 66 rated gathers
information as excellent, 78 rated understanding of patient’s
perspective as excellent, 79 rated shares information as very
good, 67 rated reaches agreement as very good, 81 rated
providing closure as excellent. Table III A statistically significant
but weak correlation exists between communication skills of
doctor and patient satisfaction level. (r=0.258, p-value<0.05)10
Table-IV
Table-I: Average scores of different components of Patient
Satisfaction Questionnaire (PSQ) (N=178)
Components
N (%)
Mean ± SD
General satisfaction
48 (26.9%)
2.8 ± 0.42
Technical quality
19 (10.7%)
2.6±0.52
Interpersonal manner
21 (11.8%)
2.8±0.33
Communication
24 (13.5%)
2.9±0.58
Financial aspect
16 (8.9%)
2.9±1.01
Time spent with doctor
33 (18.5%)
2.9±0.63
Accessibility and convenience
17 (9.5%)
2.4±0.54
Table-II: Total mean score of Patient Satisfaction
Questionnaire (PSQ) and Kalamazoo Essential Element
Communication Checklist (KEECC) (N=178)
Mean ± SD
Patient Satisfaction
19.2±1.9
Doctor Communication Skills
14.9±5.6
Table-III: Frequencies of different components of Kalamazoo Essential Element Communication Checklist (KEECC) (N=178)
Variables
Excellent
Very good
Good
Fair
Poor
Builds relationship
52 (29.2%)
76 (42.7%)
35 (19.7%)
12 (6.75%)
3(1.75%)
Opens discussion
45 (25.3%)
86 (48.3%)
30 (16.9%)
13 (7.3%)
4 (2.2%)
Gathers information
66 (37.1%)
52 (29.2%)
39 (21.9%)
17 (9.6%)
14 (2.2%)
Understandings of patient’s perspective
78 (43.8%)
43 (24.2%)
33 (18.5%)
21 (11.8%)
3 (1.7%)
Shares information
45 (25.3%)
79 (44.3%)
38 (21.3%)
14 (17.9%)
2 (1.1%)
Reaches agreement
48 (27.0%)
67 (37.6%)
35 (19.7%)
19 (10.7%)
9 (5.1%)
Provides closure
81 (45.5%)
37 (70.8%)
31 (17.4%)
15 (8.4%)
14 (7.9%)

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Table-IV: Co-relation of Kalamazoo Essential Element
Communication Checklist (KEECC) and patient satisfaction
questionnaire (PSQ-18) (N=178)
Correlation
R
P
Kalamazoo essential element
communication checklist KEECC and
patient satisfaction questionnaire PSQ
0.258
0.000
DISCUSSION
This study comprehensively describes the effect of
communication skills of a doctor on patient satisfaction level. A
study conducted by Douglas Klein indicated that there is a
positive association between communication and patient
satisfactory rates. It clearly stated that change in assessment
and communication would create a change in practice and it
shows an increase in satisfaction level of the patient.2
The study conducted by Moore, indicated that a doctor is
considered to be the best that has the most efficacious
communication with his patient. The doctor should open a
session with greetings, assemble all information, and elaborate
disease and its treatment and then end up with the session. He
also indicated that with the increase in efficacy of
communication, the gratification of the patient also
increases.3Street et al. investigated the study to find how
communication heals and improves health outcomes. They did
an observational study on clinician and patients. They
concluded that talk has also a therapeutic effect and they
design pathways to effective communication strategies such as
trust, understanding, support, attention and clear verbal
interactions.6
A study conducted by Levinson indicates that skills of doctor to
communicate with the patient have a great impact on patient
satisfaction level. In order to provide patient-centered care,
these skills are mandatory for a doctor to provide appropriate
treatment, satisfaction, and management of the
patient.8Levinson, conducted a study about the development
of physician’s communication skills for patient-centered care.
They used to collect data from direct observation of
communication skills and interviews of patients and surveys
about their experiences and health outcomes. They came to an
end by knowing that physician must be trained in a set of
communication skills in order to provide improved patient-
centered treatment.8Andrew B Symonsdid a study to find
communication skills on patient outcomes. He found that
males are good at elaborating things to doctors. The doctors
having enough strategies deal far much better with the
patients than others and patient’s satisfaction level also rises.9
Symons and colleagues analyzed that for a physician, effective
communication skills and professionalism is very important in
order to give the best treatment and to have better treatment
outcomes. They collected data from 130 residents from non-
surgical and surgical programs. It was a survey questionnaire.
They took the survey from modified form of ABIM’s patient
assessment survey. They conclude that language barriers and
inappropriate explanation of treatment to a patient are basic
issues which may arise due to demographic differences in self-
perceived communication skills.9
Ford et al, conducted study and concluded that the
communication is an art of a doctor. Regarding the
effectiveness of communication, religious and spirituals values
should be considered during a session with a patient’s
enhanced level of trust and comfort and ultimately leads to
high satisfactory rates.11Mercer conducted a study on 81
patients and stated that the patients treated with respect,
proper attention, care, and concern are more satisfied than
those who are not treated well and welcomed with
greetings.12Another study conducted by Kripalani stated clearly
that poor communication and inappropriate information to the
patient will have negative impacts on patient satisfaction level
and it also affects patients care during his follow-up sessions.13
The study conducted by Leary in which he concluded that the
Patient satisfaction has no impact communication-skills of
hospitalists because of the small sample size14The present
study is on “effects of communication skills of a doctor on
patient satisfaction level”. The main aim of this study was to
find effects of communication skills of adoctor on patient’s
level of satisfaction. This study concluded that communication
skills of doctor have an effect on patient satisfaction level.
Results revealed that it is statistically significant but weak
correlation between communication and satisfaction level.
Results of other studies also suggest that there is a significant
association between patient satisfactory rates and
communication of doctor. Verbal and non-verbal elements as
well as culture, spiritual and demographic factors should be
considered to communicate with the patient as these factors
have a direct effect on the level of comfort, trust, and
satisfaction of the patient and this will eventually lead towards
improved outcomes and better satisfactory rates.
CONCLUSION
Interpersonal communication skills of doctor have a strong
impact on patient satisfaction level.
ETHICAL CONSIDERATION
Ethical approval was taken from Research Review Committee
of Services Hospital Lahore, Jinnah Hospital Lahore, GHQ D.G
Khan, Nishtar Hospital Multan, CMH Wah Cantt, Punjab
medical center, Rasheed hospital Lahore.
CONTRIBUTION OF AUTHORS
Tanveer F: Conceived idea, Designed methodology, Manuscript
writing
Shahid S: Data collection, Statistical analysis
Hafeez MM: Data analysis and interpretation
Disclaimer: None.
Conflict of Interest: None.
Source of Funding: None.

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REFERENCES
1. Boissy A, Windover AK, Bokar D, Karafa M, Neuendorf K,
Frankel RM, et al. Communication skills training for
physicians improves patient satisfaction. J general internal
medicine. 2016;31(7):755-61.
2. Klein D, Nagji A. Assessment of communication skills in
family medicine. Canadian Family Physician.
2015;61(9):412-16.
3. Moore P, Gómez G, Kurtz S, Vargas A. Doctor patient
communication: which skills are effective? Revista médica
de Chile. 2010;138(8):1047-54.
4. Zill JM, Christalle E, Müller E, Härter M, Dirmaier J, Scholl I.
Measurement of physician-patient communication—a
systematic review. PLoS one. 2014;9(12):e112637.
5. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah
P, Baker DW. Deficits in communication and information
transfer between hospital-based and primary care
physicians: implications for patient safety and continuity of
care. JAMA. 2007;297(8):831-41.
6. Street RL, Makoul G, Arora NK, Epstein RM. How does
communication heal? Pathways linking clinician–patient
communication to health outcomes. Patient Edu Counsel.
2009;74(3):295-301.
7. Loh A, Leonhart R, Wills CE, Simon D, Härter M. The impact
of patient participation on adherence and clinical outcome
in primary care of depression. Patient Edu counsel.
2007;65(1):69-78.
8. Levinson W, Lesser CS, Epstein RM. Developing physician
communication skills for patient-centered care. Health
Affairs. 2010;29(7):1310-18.
9. Symons AB, Swanson A, McGuigan D, Orrange S, Akl EA. A
tool for self-assessment of communication skills and
professionalism in residents. BMC Med Edu. 2009;9(1):1.
10. Lee JA, Soutar GN, Sneddon J. Personal values and social
marketing: Some research suggestions. J Res Cons.
2010(18):1.
11. Ford DW, Downey L, Engelberg R, Back AL, Curtis JR.
Discussing religion and spirituality is an advanced
communication skill: an exploratory structural equation
model of physician trainee self-ratings. J Palliative Med.
2012;15(1):63-70.
12. Mercer LM, Tanabe P, Pang PS, Gisondi MA, Courtney DM,
Engel KG, et al. Patient perspectives on communication
with the medical team: Pilot study using the
communication assessment tool-team (CAT-T). Pat Edu
Counsel. 2008;73(2):220-23.
13. Gulshan V, Peng L, Coram M. Development and validation
of a deep learning algorithm for detection of diabetic
retinopathy in retinal fundus photographs. JAMA.
2016;316(22):2402-10.
14. leary KJ, Darling TA, Rauworth J, Williams MV. Impact of
hospitalist communication‐skills training on
patient‐satisfaction scores. J Hospital Med. 2013;8(6):315-
20.