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

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ORIGINALARTICLE ISRA MEDICAL JOURNAL | Volume 10 - Issue 5 | SepOct 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
Fahad Tanveer et al ISRA MEDICAL JOURNAL | Volume 10 - Issue 5 | SepOct 2018
307
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)
Excellent
Very good
Good
Fair
Poor
52 (29.2%)
76 (42.7%)
35 (19.7%)
12 (6.75%)
3(1.75%)
45 (25.3%)
86 (48.3%)
30 (16.9%)
13 (7.3%)
4 (2.2%)
66 (37.1%)
52 (29.2%)
39 (21.9%)
17 (9.6%)
14 (2.2%)
78 (43.8%)
43 (24.2%)
33 (18.5%)
21 (11.8%)
3 (1.7%)
45 (25.3%)
79 (44.3%)
38 (21.3%)
14 (17.9%)
2 (1.1%)
48 (27.0%)
67 (37.6%)
35 (19.7%)
19 (10.7%)
9 (5.1%)
81 (45.5%)
37 (70.8%)
31 (17.4%)
15 (8.4%)
14 (7.9%)
Fahad Tanveer et al ISRA MEDICAL JOURNAL | Volume 10 - Issue 5 | SepOct 2018
308
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.
Fahad Tanveer et al ISRA MEDICAL JOURNAL | Volume 10 - Issue 5 | SepOct 2018
309
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20.
... Deribew et al. [22] demonstrated that training of households through interpersonal interaction resulted in a decrease in malaria cases in selected areas in Ethiopia. Tanveer et al. [23] conducted a study with the objective to determine the association between interpersonal communication skills of medical doctors and efficiency of healthcare service delivery and reported that medical doctors with better interpersonal communication skills are more likely to effectively address patients' needs than those with low interpersonal communication skills. Prilutski [24] in a study also reported that interpersonal communication is one of the most effective communication tools in health promotion and concluded that interpersonal communication integrated at a local community level is the most all-around efficient strategy that will substantially influence change in health behaviour of rural people in Ghana. ...
... A similar situation played out with knowledge of COVID-19 among the sample studied. The result of this study is similar to those of previous scholars [22][23][24][25] who reported that interpersonal communication is effective in health care promotion. What this means is that when interpersonal communication is applied, it could successfully create awareness about the Coronavirus pandemic as well as improve knowledge of rural dwellers about the disease. ...
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... Breaking bad news to a patient in a language they do not understand and by using a translator does have a negative impact on the doctor-patient relationship and the therapeutic relationship between the two. 14 Of those in support of communication being assessed in the specialist exams, 81.5% of neurologists and 50.0% of registrars felt that this should be tested at an objectively structured practical exam (OSPE). The Canadian neurology board exam allocates one of the 10 stations to communication where difficult and challenging communication issues in neurology are tested. ...
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Effective communication skills and professionalism are critical for physicians in order to provide optimum care and achieve better health outcomes. The aims of this study were to evaluate residents' self-assessment of their communication skills and professionalism in dealing with patients, and to evaluate the psychometric properties of a self-assessment questionnaire. A modified version of the American Board of Internal Medicine's (ABIM) Patient Assessment survey was completed by 130 residents in 23 surgical and non-surgical training programs affiliated with a single medical school. Descriptive, regression and factor analyses were performed. Internal consistency, inter-item gamma scores, and discriminative validity of the questionnaire were determined. Factor analysis suggested two groups of items: one group relating to developing interpersonal relationships with patients and one group relating to conveying medical information to patients. Cronbach's alpha (0.86) indicated internal consistency. Males rated themselves higher than females in items related to explaining things to patients. When compared to graduates of U.S. medical schools, graduates of medical schools outside the U.S. rated themselves higher in items related to listening to the patient, yet lower in using understandable language. Surgical residents rated themselves higher than non-surgical residents in explaining options to patients. This appears to be an internally consistent and reliable tool for residents' self-assessment of communication skills and professionalism. Some demographic differences in self-perceived communication skills were noted.
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Importance: Deep learning is a family of computational methods that allow an algorithm to program itself by learning from a large set of examples that demonstrate the desired behavior, removing the need to specify rules explicitly. Application of these methods to medical imaging requires further assessment and validation. Objective: To apply deep learning to create an algorithm for automated detection of diabetic retinopathy and diabetic macular edema in retinal fundus photographs. Design and setting: A specific type of neural network optimized for image classification called a deep convolutional neural network was trained using a retrospective development data set of 128 175 retinal images, which were graded 3 to 7 times for diabetic retinopathy, diabetic macular edema, and image gradability by a panel of 54 US licensed ophthalmologists and ophthalmology senior residents between May and December 2015. The resultant algorithm was validated in January and February 2016 using 2 separate data sets, both graded by at least 7 US board-certified ophthalmologists with high intragrader consistency. Exposure: Deep learning-trained algorithm. Main outcomes and measures: The sensitivity and specificity of the algorithm for detecting referable diabetic retinopathy (RDR), defined as moderate and worse diabetic retinopathy, referable diabetic macular edema, or both, were generated based on the reference standard of the majority decision of the ophthalmologist panel. The algorithm was evaluated at 2 operating points selected from the development set, one selected for high specificity and another for high sensitivity. Results: The EyePACS-1 data set consisted of 9963 images from 4997 patients (mean age, 54.4 years; 62.2% women; prevalence of RDR, 683/8878 fully gradable images [7.8%]); the Messidor-2 data set had 1748 images from 874 patients (mean age, 57.6 years; 42.6% women; prevalence of RDR, 254/1745 fully gradable images [14.6%]). For detecting RDR, the algorithm had an area under the receiver operating curve of 0.991 (95% CI, 0.988-0.993) for EyePACS-1 and 0.990 (95% CI, 0.986-0.995) for Messidor-2. Using the first operating cut point with high specificity, for EyePACS-1, the sensitivity was 90.3% (95% CI, 87.5%-92.7%) and the specificity was 98.1% (95% CI, 97.8%-98.5%). For Messidor-2, the sensitivity was 87.0% (95% CI, 81.1%-91.0%) and the specificity was 98.5% (95% CI, 97.7%-99.1%). Using a second operating point with high sensitivity in the development set, for EyePACS-1 the sensitivity was 97.5% and specificity was 93.4% and for Messidor-2 the sensitivity was 96.1% and specificity was 93.9%. Conclusions and relevance: In this evaluation of retinal fundus photographs from adults with diabetes, an algorithm based on deep machine learning had high sensitivity and specificity for detecting referable diabetic retinopathy. Further research is necessary to determine the feasibility of applying this algorithm in the clinical setting and to determine whether use of the algorithm could lead to improved care and outcomes compared with current ophthalmologic assessment.
Article
Objective: To assess the communication and interviewing skills of incoming residents and provide formative feedback to residents early in their training. Design: New residents completed a 15-minute Objective: structured clinical examination (OSCE) assessing communication skills and a 12-question, self-administered content quiz at the start of their residency. Each resident was directly observed by a family physician in the OSCE and provided with 15 minutes of structured feedback, with an opportunity for questions and discussion. The entire process remained private and did not affect summative evaluations. Setting: Family medicine residency training program at the University of Alberta in Edmonton. Participants: First-year family medicine residents. Main outcome measures: Residents' scores on the OSCE and the content quiz; residents' rating of the usefulness of the assessment and the likelihood it would lead to practice change. Results: A total of 61 residents (93.8%) completed the skills assessment (50 Canadian graduates, 11 international graduates). The mean score for the content quiz was 20.6 out of a total possible score of 24. Resident scores ranged from 8 to 24. The mean score on the OSCE practice interview was 21.1 out of 30, with a range of 13 to 29. Learner feedback indicated that the skills assessment was useful (4.68 out of 6) and would lead to a change in practice (4.43 out of 6). Conclusion: The introductory communication OSCE and quiz offer new residents an opportunity to gauge their baseline skill level, become aware of program expectations early in their training, and garner specific suggestions in a nonthreatening environment. This tailored approach helps orient residents while taking into account their previous experiences.
Article
Communication about religious and spiritual issues is fundamental to palliative care, yet little empirical data exist to guide curricula in this area. The goal of this study was to develop an improved understanding of physicians' perspectives on their communication competence about religious and spiritual issues. We examined surveys of physician trainees (n=297) enrolled in an ongoing communication skills study at two medical centers in the northwestern and southeastern United States. Our primary outcome was self-assessed competence in discussing religion and spirituality. We used exploratory structural equation modeling (SEM) to develop measurement and full models for acquisition of self-assessed communication competencies. Our measurement SEM identified two latent constructs that we label Basic and Intermediate Competence, composed of five self-assessed communication skills. The Basic Competence construct included overall satisfaction with palliative care skills and with discussing do not resuscitate (DNR) status. The Intermediate Competence construct included responding to inappropriate treatment requests, maintaining hope, and addressing fears about the end-of-life. Our full SEM model found that Basic Competence predicted Intermediate Competence and that Intermediate Competence predicted competence in religious and spiritual discussions. Years of clinical training directly influenced Basic Competence. Increased end-of-life discussions positively influenced Basic Competence and had a complex association with Intermediate Competence. Southeastern trainees perceived more competence in religious and spiritual discussions than northwestern trainees. This study suggests that discussion of religious and spiritual issues is a communication skill that trainees consider more advanced than other commonly taught communication skills, such as discussing DNR orders.
Article
Effective communication is an essential aspect of high-quality patient care and a core competency for physicians. To date, assessment of communication skills in team-based settings has not been well established. We sought to tailor a psychometrically validated instrument, the Communication Assessment Tool, for use in Team settings (CAT-T), and test the feasibility of collecting patient perspectives of communication with medical teams in the emergency department (ED). A prospective, cross-sectional study in an academic, tertiary, urban, Level 1 trauma center using the CAT-T, a 15-item instrument. Items were answered via a 5-point scale, with 5 = excellent. All adult ED patients (> or = 18 y/o) were eligible if the following exclusion criteria did not apply: primary psychiatric issues, critically ill, physiologically unstable, non-English speaking, or under arrest. 81 patients were enrolled (mean age: 44, S.D. = 17; 44% male). Highest ratings were for treating the patient with respect (69% excellent), paying attention to the patient (69% excellent), and showing care and concern (69% excellent). Lowest ratings were for greeting the patient appropriately (54%), encouraging the patient to ask questions (54%), showing interest in the patient's ideas about his or her health (53% excellent), and involving the patient in decisions as much as he or she wanted (53% excellent). Although this pilot study has several methodological limitations, it demonstrates a signal that patient assessment of communication with the medical team is feasible and offers important feedback. Results indicate the need to improve communication in the ED. In the ED, focusing on the medical team rather then individual caregivers may more accurately reflect patients' experience.