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Arwa Abdullah Aseeri et al, 2019;3(1):120–123.

International Journal of Medicine in Developing Countries

Physician–patient communication in the primary care clinics

Arwa Abdullah Aseeri1*, Abdulmajeed Eidhah Alswat2, Abdulelah Mohamed Alessa2, Abdulrahman Fahad Alaql2, Osama Sulaiman Alkhudhairi2, Majed Hassan Alghamdi3, Maram Mubarak Barkoot2, Sahab Mohammed Alsari2, Faris Mohammed Alreshidi4, Maha Fahad Alluqmani5

Correspondence to: Arwa Abdullah Aseeri

*College of Medicine, King Khalid University, Saudi Arabia.

Email: Aarwaa1994 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 09 December 2018 | Accepted: 15 December 2018


ABSTRACT

Background:

Physician–patient communication is a critical component not only of primary medical care but also for all of the health care. Communication may be through verbal or non-verbal means, each of them has its efficiency in affecting patient’s interaction with the physician. Successful physician–patient communication could lead to favorable patient outcomes, but poor performance during physician–patient communication may have consequences. Physician’s attitude, reactions, position, behaviors, and many other aspects also have a great impression on the therapeutic communication outcomes. This review was done to determine common reasons for poor physicians’ performance in physician–patient communication in primary health care.


Methodology:

Scientific websites were used to search for articles related to the topic such as PubMed and Google Scholar using several keywords including physician–patient communication, physician–patient relationship, and barriers of physician–patient communication.


Results:

A total of 32 articles were obtained, 25 of them were included, and they were published between the years 1979 and 2017, whereas those who excluded were not focusing on the current aim.


Conclusion:

Low medical literacy of patients, the high workload for physicians, and low awareness of communication skills lead to failure of expressing a friendly attitude towards patients or involving them in decision making which leads to patient’s distrust and defensive behavior and then the failure of the full collection of patient information.


Keywords:

Communication, barriers, physician–patient, relationship, primary health care.

Introduction

The relationship between patients and healthcare providers has deteriorated over the past years [1]. The tension in the relationship between physicians and patients is due to the poor quality of communication during consultations [2]. Physician–patient communication can impact the trust between physicians and patients [3]. When a patient does not believe in the physician, a patient may have doubts about the physician’s decisions, which lead to medical complaints [4]. Physicians’ attitude perceived by patients plays an important role in gaining his satisfaction [5], so physicians’ communication skills are believed to improve physician–patient relationship [6]. Behaviors, such as caring, explaining, encouraging, and demonstrating competency from doctors make patients tend to trust the doctors better [3]. A long-term relationship with patients also helps them to understand physicians better and to gain more trust in them [7]. When physicians perceive patients’ distrust, they would feel more psychological pressure and tend to be more cautious with them [8], and then may adopt defensive behaviors such as prescription of unnecessary drugs or clinical tests and scheduling of unnecessary therapeutic procedures. Defensive behaviors increase medical expenses and expose patients to unnecessary risks, even death, in some cases [9]. Physicians’ defensive behaviors impair patients’ trust and lead to more defensive behaviors in turn [10]. This review aimed to determine common reasons for poor physicians’ performance in physician–patient communication in primary health care.

Materials and Methods

The present review included 25 research articles that were obtained by online research. Several keywords were used to search for articles related to the current subjects in scientific websites such as PubMed and Google Scholar, these keywords included Communication, Barriers, Physician–patient, Relationship, primary health care. A total number of 32 articles were obtained, 25 of them were included, and 7 were excluded as they involved other related topics and did not focus on the current aim. The included articles were published between the years 1979 and 2017.

Discussion

Physician–patient communication

A communicative physician–patient relationship is significant, especially in the management of chronic diseases, such as diabetes, hypertension, coronary artery disease, and congestive heart failure [11]. When patients are informed and involved in decision making, they are more adherent to recommendations and carry out more health-related behavior change (e.g., exercise, smoking cessation, and dietary modification) [12]. Patients considered communication to be one of the top three competencies a physician should possess, yet they frequently rated their own physicians’ communication skills to be unsatisfactory. These and related findings suggest the need for enhanced attention to communication skills in physician’s education and quality improvement in family practice. Such activities should be based on empirical data showing which aspects of a physician’s behavior are critical to a patient’s outcomes [13].

Behaviors commonly causing poor physician–patient communication

Those behaviors associated with unfavorable outcomes included more patient gaze, body orientation 45° to 90° away from the patient, indirect body orientation, backward lean, crossed arms, task touch, and many touches. No association could be found for sideways leaning, leg position, arm position asymmetry, amount of physical touch, and physician–patient distance [14]. The following behaviors have been shown to be negatively associated with patient outcomes: passive acceptance, negative social-emotional interactions, formal behavior, antagonism and passive rejection (non-integrative behavior), high rates of biomedical questioning, interruptions, a one way information flow from the patient to the provider (information collection without feedback), antagonistic behavior, directive behavior, utterances concerning the patients experience or showing interest in the patient (attentiveness), irritation, nervousness, extensive feedback given in the concluding part of the visit, anxiety or tension, dominance, directiveness, and expression of opinion during the physical examination [14]. Physicians made eye contact with patients in 88% of the encounters, had a social talk with patients in 16% of the encounters, and expressed personal feelings (such as caring, concern, and empathy) in 19% of the encounters. However, only a few physicians maintained a long-term relationship with patients (3%). Several improper behaviors were observed: interrupting while the patient is speaking (16% of the encounters), chatting with irrelevant people (7% of the encounters), using jargon without explanation (6% of the encounters), and ignoring patients’ questions (6% of the encounters) [15].

Common Causes for poor physician–patient communication

The reasons for the poor performance of the physicians in communication are complex. Possible reasons include a high workload for physicians, lack of medical training in communication skills, and a weak healthcare system. Physicians generally failed to realize the importance of communication skills or the relationship between physicians and patients in improving physician–patient communication. Moreover, they tended to attribute medical conflicts to their high workload or patients’ low medical literacy. The high workload was a primary reason for poor communication skills. Physicians have limited time for each patient, and sometimes it is impossible to deliver a satisfactory service in the short time scheduled for consultations. The low medical literacy of patients worsens the condition and it requires more skills of physicians to communicate with the patients [15].

Behaviors commonly causing good physician–patient communication

Physician behaviors were found to be positively associated with health outcomes. These behaviors included the physician’s expression of intellectual appreciation of a patient’s situation (empathy as a discrete variable) [16], empathy as a global assessment variable [17], provider statements of reassurance or support, and encouragement of the physician for patient’s questions (patient-centered behavior) [18], allowing the patient’s point of view to guide the conversation in the concluding part of the visit [19], high proportion of objective statements in the concluding part of the visit (explanation) [20], a predominantly passive physician [21], a physician’s expression of positive reinforcement or good feelings of the provider in regard to patient’s actions, possessions, or self (encouragement) [16], laughing and joking from the provider’s side (tension release) [21], physicians who addressed problems of daily living, social relations, feelings, and emotions of the patients (psychosocial talk) [22], question (both closed and open-ended) asking about and counseling for psychosocial issues [22], increased time on health education [23], sharing medical data with the patient [24], discussion of treatment effects [23], friendliness [22], courtesy [17], receptivity to patient’s questions and statements (listening behavior) [17], summarization, talking at the patient’s level, and clarifying statements (information giving) [17], a more dominant physician [22], orienting the patient during the physical examination [25], increased encounter length [17], and more time spent on history taking [23], or patient health education [23].

Conclusion

Low medical literacy of patients, the high workload for physicians, and low awareness of communication skills lead to failure of expressing a friendly attitude towards patients or involving them in decision making which leads to patient’s distrust and defensive behavior and then the failure of the full collection of patient information.

List of Abbreviations

None.


Funding

None.


Declaration of conflicting interests

None.


Consent for publication

Not applicable.


Ethical approval

Not applicable.


Author details

Arwa Abdullah Aseeri1, Abdulmajeed Eidhah Alswat2, Abdulelah Mohamed Alessa2, Abdulrahman Fahad Alaql2, Osama Sulaiman Alkhudhairi2, Majed Hassan Alghamdi3, Maram Mubarak Barkoot2, Sahab Mohammed Alsari2, Faris Mohammed Alreshidi4, Maha Fahad alluqmani5

  1. Medical College, King Khalid University, Abha, Saudi Arabia
  2. College of Medicine, Imam Mohammed Bin Saud University, Riyadh, Saudi Arabia
  3. Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  4. Medical College, University of Hail, Hayil, Saudi Arabia
  5. Medical college, Ibn Sina National College, Jeddah, Saudi Arabia

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How to Cite this Article
Pubmed Style

Aseeri AA, Alswat AE, Alessa nM, ALAql AF, Alkhudhairi OS, Alghamdi MH, Barkoot MM, Alsari SM, Alreshidi FM, Alluqmani MF, . Physician-patient communication in the primary care clinics. IJMDC. 2019; 3(1): 120-123. doi:10.24911/IJMDC.51-1544387594


Web Style

Aseeri AA, Alswat AE, Alessa nM, ALAql AF, Alkhudhairi OS, Alghamdi MH, Barkoot MM, Alsari SM, Alreshidi FM, Alluqmani MF, . Physician-patient communication in the primary care clinics. https://www.ijmdc.com/?mno=20919 [Access: January 28, 2022]. doi:10.24911/IJMDC.51-1544387594


AMA (American Medical Association) Style

Aseeri AA, Alswat AE, Alessa nM, ALAql AF, Alkhudhairi OS, Alghamdi MH, Barkoot MM, Alsari SM, Alreshidi FM, Alluqmani MF, . Physician-patient communication in the primary care clinics. IJMDC. 2019; 3(1): 120-123. doi:10.24911/IJMDC.51-1544387594



Vancouver/ICMJE Style

Aseeri AA, Alswat AE, Alessa nM, ALAql AF, Alkhudhairi OS, Alghamdi MH, Barkoot MM, Alsari SM, Alreshidi FM, Alluqmani MF, . Physician-patient communication in the primary care clinics. IJMDC. (2019), [cited January 28, 2022]; 3(1): 120-123. doi:10.24911/IJMDC.51-1544387594



Harvard Style

Aseeri, A. A., Alswat, . A. E., Alessa, . n. M., ALAql, . A. F., Alkhudhairi, . O. S., Alghamdi, . M. H., Barkoot, . M. M., Alsari, . S. M., Alreshidi, . F. M., Alluqmani, . M. F. & (2019) Physician-patient communication in the primary care clinics. IJMDC, 3 (1), 120-123. doi:10.24911/IJMDC.51-1544387594



Turabian Style

Aseeri, Arwa Abdullah, Abdulmajeed Eidhah Alswat, nAbdulelah Mohamed Alessa, Abdulrahman Fahad ALAql, Osama Sulaiman Alkhudhairi, Majed Hassan Alghamdi, Maram Mubarak Barkoot, Sahab Mohammed Alsari, Faris Mohammed Alreshidi, Maha Fahad Alluqmani, and . 2019. Physician-patient communication in the primary care clinics. International Journal of Medicine in Developing Countries, 3 (1), 120-123. doi:10.24911/IJMDC.51-1544387594



Chicago Style

Aseeri, Arwa Abdullah, Abdulmajeed Eidhah Alswat, nAbdulelah Mohamed Alessa, Abdulrahman Fahad ALAql, Osama Sulaiman Alkhudhairi, Majed Hassan Alghamdi, Maram Mubarak Barkoot, Sahab Mohammed Alsari, Faris Mohammed Alreshidi, Maha Fahad Alluqmani, and . "Physician-patient communication in the primary care clinics." International Journal of Medicine in Developing Countries 3 (2019), 120-123. doi:10.24911/IJMDC.51-1544387594



MLA (The Modern Language Association) Style

Aseeri, Arwa Abdullah, Abdulmajeed Eidhah Alswat, nAbdulelah Mohamed Alessa, Abdulrahman Fahad ALAql, Osama Sulaiman Alkhudhairi, Majed Hassan Alghamdi, Maram Mubarak Barkoot, Sahab Mohammed Alsari, Faris Mohammed Alreshidi, Maha Fahad Alluqmani, and . "Physician-patient communication in the primary care clinics." International Journal of Medicine in Developing Countries 3.1 (2019), 120-123. Print. doi:10.24911/IJMDC.51-1544387594



APA (American Psychological Association) Style

Aseeri, A. A., Alswat, . A. E., Alessa, . n. M., ALAql, . A. F., Alkhudhairi, . O. S., Alghamdi, . M. H., Barkoot, . M. M., Alsari, . S. M., Alreshidi, . F. M., Alluqmani, . M. F. & (2019) Physician-patient communication in the primary care clinics. International Journal of Medicine in Developing Countries, 3 (1), 120-123. doi:10.24911/IJMDC.51-1544387594