The ability of a behaviour-specific patient questionnaire to identify poorly performing doctors

Akershus University Hospital, HØKH Research Centre, Postboks 95, 1478 Lørenskog, Norway
BMJ quality & safety (Impact Factor: 3.99). 08/2011; 20(10):885-93. DOI: 10.1136/bmjqs-2011-000021
Source: PubMed


Doctors' ability to communicate with patients varies. Patient questionnaires are often used to assess doctors' communication skills.
To investigate whether the Four Habits Patient Questionnaire (4HPQ) can be used to assess the different skill levels of doctors.
A cross-sectional study of 497 hospital encounters with 71 doctors. Encounters were videotaped and patients completed three post-visit questionnaires.
A 500-bed general teaching hospital in Norway.
The proportion of video-observed between-doctor variance that could be predicted by 4HPQ.
There were strong correlations between all patient-reported outcomes (range 0.71-0.80 at the doctor level, p < 0.01). 4HPQ correlated significantly with video-observed behaviour at the doctor level (Pearson's r = 0.42, p<0.01) and the encounter level (Pearson's r = 0.27, p < 0.01). The proportion of between-doctor variance not detectable by 4HPQ was 88%. The reason for this discordance was large within-doctor between-encounter variance observed in the videos, and small between-patient variance in patient reports. The maximum positive predictive value for the identification of poorly performing doctors (92%) was achieved with a cut-off score for 4HPQ of 82% (ie, patient assessments were concordant with expert observers for these doctors).
Using a patient-reported questionnaire of doctors' communication skills, favourable assessments of doctors by patients were mostly discordant with the views of expert observers. Only very poor performance identified by patients was in agreement with the views of expert observers. The results suggest that patient reports alone may not be sufficient to identify all doctors whose communication skills need improvement training.

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Available from: Bård Fossli Jensen, Feb 04, 2014
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    • ".and in the presented encounters it would be likely that the patients would respond that the efforts were strong. We have previously reported limited strength of association on visit level between patient and observer reported data on specific physician behaviours [39]. The present detailed analysis helps to explain why. "
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    ABSTRACT: Objective To explore how physician efforts to involve patients in medical decisions align with established core elements of shared decision making (SDM). Methods Detailed video analysis of two hospital outpatient encounters, selected because the physicians exhibited much effort to involve the patients in decision making, and because the final decisions were not what the physicians had initially recommended. The analysis was supplied by physician, patient, and observer-rated data from a total of 497 encounters collected during the same original study. The observer-rated data confirmed that these physicians demonstrated above average patient-centred skills in this material. Results Behaviors of these two not trained physicians demonstrated confusion about how to perform SDM. Information provided to the patients was imprecise and ambiguous. Insufficient patient involvement did not prompt the physicians to change strategy. Physician and patient reports indicated awareness of suboptimal communication. Co***nclusion Inadequate SDM in hospital encounters may introduce confusion. Quantitative evaluations by patients and observers may reflect much effort rather than process quality. Practice implications SDM may be discredited because the medical community has not acquired the necessary skills to perform it, even if it is ethically and legally mandated. Training and supervision should follow regulations and guidelines.
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