Assessment of mutual understanding of physician patient encounters: development and validation of a Mutual Understanding Scale (MUS) in a multicultural general practice setting.

Mutual understanding between physician and patient is essential for good quality of care; however, both parties have different views on health complaints and treatment. This study aimed to develop and validate a measure of mutual understanding (MU) in a multicultural setting. The study included 986 patients from 38 general practices. GPs completed a questionnaire and patients were interviewed after the consultation. To assess mutual understanding the answers from GP and patient to questions about different consultation aspects were compared. An expert panel, using nominal group technique, developed criteria for mutual understanding on consultation aspects and secondly, established a ranking to combine all aspects into an overall consultation judgement. Regarding construct validity, patients' ethnicity, age and language proficiency were the most important predictors for MU. Regarding criterion validity, all GP-related criteria (the GPs perception of his ability to explain to the patient, the patient's ability to explain to the GP, and the patient's understanding of consultation aspects), were well-related to MU. The same can be said of patient's consultation satisfaction and feeling that the GP was considerate. We conclude that the Mutual Understanding Scale is regarded a reliable and valid measure to be used in large-scale quantitative studies.

[1]  L. Sachs.  Misunderstanding as therapy: Doctors, patients and medicines in a rural clinic in Sri Lanka , 1989, Culture, medicine and psychiatry.

[2]  M. Calnan,et al.  Major determinants of consumer satisfaction with primary care in different health systems. , 1994, Family practice.

[3]  M. Weiss,et al.  Cultural models of diarrheal illness: conceptual framework and review. , 1988, Social science & medicine.

[4]  A. Kleinman,et al.  Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry. , 1983 .

[5]  Jatinder N. D. Gupta,et al.  The Impact of Decision-Making Methodology on Job Evaluation Outcomes , 1994 .

[6]  J. Lynch,et al.  Doctor-patient communications in a private family practice. , 1976, The Journal of family practice.

[7]  D W Baker,et al.  Use and effectiveness of interpreters in an emergency department. , 1996, JAMA.

[8]  M. Foets,et al.  Migranten in de huisartspraktijk: andere klachten en diagnosen dan Nederlanders. , 1998 .

[9]  P. Sloane,et al.  Physician-patient communication in the primary care office: a systematic review. , 2002, The Journal of the American Board of Family Practice.

[11]  R. Bartz.  Beyond the biopsychosocial model: new approaches to doctor-patient interactions. , 1999, The Journal of family practice.

[12]  H. Tange.  How to approach the structuring of the medical record? Towards a model for flexible access to free text medical data. , 1996, International Journal of Bio-Medical Computing.

[13]  W. Vetter,et al.  [Patient compliance/noncompliance, determining factors, physician-patient interaction]. , 1994, Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis.

[14]  A Donabedian,et al.  The seven pillars of quality. , 1990, Archives of pathology & laboratory medicine.

[15]  D W Cecil,et al.  Control, compliance, and satisfaction in the family practice encounter. , 1997, Family medicine.

[16]  Wendy K. Enochs.  Culture and Clinical Care , 2006 .

[17]  L. Pachter.  Culture and clinical care. Folk illness beliefs and behaviors and their implications for health care delivery. , 1994, JAMA.

[18]  M. Bruijnzeels,et al.  Intercultural communication in general practice. , 2002, European journal of public health.

[19]  H. Hearnshaw,et al.  Which aspects of general practitioners' behaviour determine patients' evaluations of care? , 1998, Social science & medicine.

[20]  M. Roland,et al.  Defining quality of care. , 2000, Social science & medicine.

[21]  C Lister,et al.  An evidence-based approach , 1998, British Dental Journal.

[22]  A. Kleinman.  The cultural meanings and social uses of illness. A role for medical anthropology and clinically oriented social science in the development of primary care theory and research. , 1983, The Journal of family practice.

[23]  R. Littlewood,et al.  Patient Satisfaction: Ethnic Origin or Explanatory Model? , 1998, The International journal of social psychiatry.

[24]  R. Brook,et al.  Consensus methods: characteristics and guidelines for use. , 1984, American journal of public health.

[25]  L. Meeuwesen,et al.  When cultures meet in general practice: intercultural differences between GPs and parents of child patients. , 2003, Patient education and counseling.

[26]  Debra L Roter,et al.  Patient-Centered Communication, Ratings of Care, and Concordance of Patient and Physician Race , 2003, Annals of Internal Medicine.

[27]  Fletcher Rh.  Patient compliance with therapeutic advice: a modern view. , 1989 .

[28]  J. De Maeseneer,et al.  Is GP-patient communication related to their perceptions of illness severity, coping and social support? , 2002, Social science & medicine.

[29]  D. Hunter,et al.  Qualitative Research: Consensus methods for medical and health services research , 1995 .

[30]  M. Pitts,et al.  Lay beliefs about diarrhoeal diseases: their role in health education in a developing country. , 1996, Social science & medicine.

[31]  B. Qureshi.  How to Avoid Pitfalls in Ethnic Medical History, Examination and Diagnosis , 1992, Journal of the Royal Society of Medicine.

[32]  Marlene Z. Cohen,et al.  Explanatory models of diabetes: patient practitioner variation. , 1994, Social science & medicine.

[33]  Y. Yamazaki,et al.  Relationship between outpatients' perceptions of physicians' communication styles and patients' anxiety levels in a Japanese oncology setting. , 2001, Social science & medicine.

[34]  Lynn Payer,et al.  Medicine and Culture , 1988 .

[35]  J. Ramsay,et al.  Age, gender, socioeconomic, and ethnic differences in patients' assessments of primary health care , 2001, Quality in health care : QHC.

[36]  Arthur Kleinman,et al.  Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research , 1978 .

[37]  N. Powe,et al.  Race, gender, and partnership in the patient-physician relationship. , 1999, JAMA.

[38]  J. Bensing,et al.  Gender and communication style in general practice. Differences between women's health care and regular health care. , 1998, Medical care.

[39]  G. Freeman,et al.  Non-English speakers consulting with the GP in their own language: a cross-sectional survey. , 2002, The British journal of general practice : the journal of the Royal College of General Practitioners.