Clinician Interruptions and Patient-Rated Clinician Empathy in Specialty Visits.

INTRODUCTION Clinicians tend to interrupt patients when they are describing their problem, which may contribute to feeling unheard or misunderstood. Using transcripts of audio and video recordings from musculoskeletal (MSK) specialty visits, we asked what factors are associated with (1) Perceived clinician empathy, including the time a patient spends describing the problem and time to the first interruption, (2) duration of patient symptom description, and (3) duration between the end of greeting and first nonactive listening interruption. METHODS We analyzed transcripts of 194 adult patients seeking MSK specialty care with a median age (Interquartile range [IQR]) of 47 (33 to 59) years. Participants completed postvisit measures of perceived clinician empathy, symptoms of depression, accommodation of pain, and health anxiety. A nonactive listening interruption was defined as the clinician unilaterally redirecting the topic of conversation. Factors associated with patient-rated clinician empathy, patient problem description duration, and time until the first nonactive listening interruption were sought in bivariate and multivariable analyses. RESULTS The patient's narrative was interrupted at least one time in 144 visits (74%). The duration of each visit was a median of 12 minutes (IQR 9 to 16 minutes). The median time patients spent describing their symptoms was 139 seconds before the first interruption (IQR 84 to 225 seconds). The median duration between the end of the initial greeting and the first interruption was 60 seconds (IQR 30 to 103 seconds). Clinician interruption was associated with shorter duration of symptom description. Greater perceived clinician empathy was associated with greater accommodation of pain (regression coefficient [95% confidence interval] = 0.015 [0.0005-0.30]; P = 0.04). DISCUSSION Clinician interruption was associated with shorter symptom presentation, but not with diminished perception of clinician empathy. Although active listening and avoidance of interruption are important communication tactics, other aspects of the patient-clinician relationship may have more effect on patient experience.

[1]  D. Ring,et al.  Quantitative Patient-Reported Experience Measures Derived From Natural Language Processing Have a Normal Distribution and No Ceiling Effect , 2022, Quality management in health care.

[2]  T. Crijns,et al.  Does Adjusting for Social Desirability Reduce Ceiling Effects and Increase Variation of Patient-Reported Experience Measures? , 2022, Journal of patient experience.

[3]  A. Al Salman,et al.  Do Unhelpful Thoughts or Confidence in Problem Solving Have Stronger Associations with Musculoskeletal Illness? , 2021, Clinical orthopaedics and related research.

[4]  T. Teunis,et al.  Unhelpful Thoughts and Distress Regarding Symptoms Limit Accommodation of Musculoskeletal Pain , 2021, Clinical orthopaedics and related research.

[5]  Antonio Varela,et al.  The relationship between psychosocial factors and reported disability: the role of pain self-efficacy , 2021, BMC Musculoskeletal Disorders.

[6]  James D. Doorley,et al.  Understanding barriers and facilitators to implementation of psychosocial care within orthopedic trauma centers: a qualitative study with multidisciplinary stakeholders from geographically diverse settings , 2021, Implementation Science Communications.

[7]  D. Ring,et al.  What Are the Priming and Ceiling Effects of One Experience Measure on Another? , 2020, Journal of patient experience.

[8]  D. Ring,et al.  Attempts to Limit Censoring in Measures of Patient Satisfaction , 2020, Journal of patient experience.

[9]  Dustin C. Derby,et al.  Improper Communication Makes for Squat: A Qualitative Study of the Health-Care Processes Experienced By Older Adults in a Clinical Trial for Back Pain , 2019, Journal of patient experience.

[10]  K. Kypri,et al.  Randomized trial seeking to induce the Hawthorne effect found no evidence for any effect on self-reported alcohol consumption online. , 2019, Journal of clinical epidemiology.

[11]  D. Ring,et al.  Visit Duration Does Not Correlate with Perceived Physician Empathy , 2019, The Journal of bone and joint surgery. American volume.

[12]  V. Montori,et al.  Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters , 2018, Journal of General Internal Medicine.

[13]  E. Mackenzie,et al.  Trauma Collaborative Care Intervention: Effect on Surgeon Confidence in Managing Psychosocial Complications After Orthopaedic Trauma , 2017, Journal of orthopaedic trauma.

[14]  Ari Voutilainen,et al.  How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale. , 2016, Journal of advanced nursing.

[15]  R. Street,et al.  The initial clinical interview—can it reduce cancer patients’ fear? , 2015, Supportive Care in Cancer.

[16]  B. McGuire,et al.  A 2-item short form of the Pain Self-efficacy Questionnaire: development and psychometric evaluation of PSEQ-2. , 2015, The journal of pain : official journal of the American Pain Society.

[17]  D. Ring,et al.  The pain self-efficacy questionnaire: validation of an abbreviated two-item questionnaire. , 2014, Psychosomatics.

[18]  Nathan E. Dodds,et al.  Validation of the depression item bank from the Patient-Reported Outcomes Measurement Information System (PROMIS) in a three-month observational study. , 2014, Journal of psychiatric research.

[19]  Mary Ellen Macdonald,et al.  The importance of physician listening from the patients' perspective: enhancing diagnosis, healing, and the doctor-patient relationship. , 2011, Patient education and counseling.

[20]  Mark P. Jensen,et al.  Validity of four pain intensity rating scales , 2011, PAIN®.

[21]  A. Vranceanu,et al.  Factors associated with patient satisfaction. , 2011, The Journal of hand surgery.

[22]  M. Hojat,et al.  Patient perceptions of physician empathy, satisfaction with physician, interpersonal trust, and compliance , 2010, International Journal of Medical Education.

[23]  S. L. Stewart,et al.  Abstract A25: Public and provider awareness and use of a CA‐125 test for ovarian cancer , 2010 .

[24]  T. Mcguire,et al.  Time allocation in primary care office visits. , 2007, Health services research.

[25]  Richard L Street,et al.  The Impact of Patient Participation on Physicians' Information Provision During a Primary Care Medical Interview , 2007, Health communication.

[26]  Eamonn Ferguson,et al.  "Trust me...": psychological and behavioral predictors of perceived physician empathy. , 2007, The Journal of applied psychology.

[27]  Kathryn Robertson,et al.  Active listening: more than just paying attention. , 2005, Australian family physician.

[28]  Lawrence Dyche,et al.  The effect of physician solicitation approaches on ability to identify patient concerns , 2005, Journal of General Internal Medicine.

[29]  H. Epps,et al.  Communication skills for patient-centered care : Research-based, easily learned techniques for medical interviews that benefit orthopaedic surgeons and their patients , 2005 .

[30]  L. Kirmayer,et al.  Explaining Medically Unexplained Symptoms , 2004, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[31]  C. Teutsch.  Patient-doctor communication. , 2003, The Medical clinics of North America.

[32]  A. van den Brink-muinen,et al.  Doctors' responses to patients' concerns: testing the use of sequential analysis , 2003, Epidemiologia e Psichiatria Sociale.

[33]  Charles R. Thomas,et al.  Clinicians Communicating with Patients Experiencing Cancer Pain , 2003, Cancer investigation.

[34]  J. Kleijnen,et al.  Influence of context effects on health outcomes: a systematic review , 2001, The Lancet.

[35]  M K Marvel,et al.  Soliciting the patient's agenda: have we improved? , 1999, JAMA.

[36]  S. S. Young,et al.  Resampling-Based Multiple Testing: Examples and Methods for p-Value Adjustment , 1993 .

[37]  R. Frankel,et al.  The effect of physician behavior on the collection of data. , 1984, Annals of internal medicine.

[38]  D. Ring,et al.  Factors associated with pain intensity and magnitude of limitations among people with hip and knee arthritis. , 2021, Journal of orthopaedics.

[39]  V. T. Nagy.  Clinician-Patient Communication: Its Big Impact on Health , 2001 .