Esther Khatibi
Country: USA
Background: Biology
Research Project: Patient Physician Communication: A comparison of how patient socioeconomic status and physician empathy affect the interaction.
There is a need to address inequalities in healthcare relevant to socioeconomic status. Understanding physician communication and empathy can play an important role in improving the quality of care and reducing inequalities in deprived areas.
This study used an exploratory quantitative analysis of video consultations in a primary care setting to assess the relationship between communication patterns, physician empathy and deprivation. This research used a sample of secondary data that included eight GPs working in the West of Scotland that were selected for variance in deprivation scores of their practice and their patient-rated empathy scores, as defined by the Consultation and Relational Empathy (CARE) measure. The two GPs with the highest CARE scores and the two GPs with the lowest CARE scores were selected from GPs that work with patients in areas of high deprivation. The same selection process was used for the GPs working in affluent areas. The Roter Interaction Analysis System (RIAS) was utilized to code and identify differences is sociolinguistic patterns and compare verbal utterances with the CARE and Scottish Index of Multiple Deprivation (SIMD) scores. Approximately ten consultations per GP were coded.
Results showed that high CARE GPs (i.e. those physicians who indicate a high level of empathy) demonstrated more utterances in categories associated with positive and socio-emotional talk. Yet, interestingly enough, negative rapport building utterances were increased in the high CARE group. Furthermore, the total number of patient utterances were increased in the high CARE group. When assessing high and low deprivation, the results showed that doctors asked more medical questions and gave more medical advice to those in affluent areas, while they spent more time with procedural comments such as transitions, asking the patient to repeat himself/herself, or giving ‘other’ information in high deprivation areas. Finally, when CARE scores were assessed as a factor of deprivation, the results showed an interesting correlation between dominance and the affluent/high CARE group. Also, in high deprivation areas open-ended and closed-ended psychosocial questions asked by the physician were associated with low CARE scores. On the contrary, in the affluent areas they were associated with high CARE scores. Similarly, GPs in affluent areas gave more information regarding psychosocial questions whereas there was no correlation in high deprivation areas, despite the increased number of patients presenting with psychosocial problems. As expected, positive and emotional utterances correlated with higher CARE scores.
It has been previously established by a multitude of studies that there are significant differences in physician communication in relation to patient socio-economic status. However, the results from this study contribute to this field of research by revealing specific verbal utterances that correlate with patient-rated empathy scores. It also takes a unique approach to the social exchange theory and perspective on physician dominance by recognizing the need for balance in the ratio of physician to patient utterances and on the choice of verbal utterances used to progress through the clinical encounter. The results of this study indicate that when the patient and physician share common goals and communication behaviours, a balanced level of physician dominance is not only expected but considered empathic. Recognizing and identifying specific areas of communication allows for strategic approaches in tackling and improving health inequalities in deprived areas.
Word Count: 12,423
Key Words: Patient-physician communication, General Practice, RIAS, Empathy, Socioeconomic status