Ratings of physician communication by real and standardized patients

Kevin Fiscella, Peter Franks, Malathi Srinivasan, Richard L Kravitz, Ronald Epstein

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

PURPOSE: Patient ratings of physician's patient-centered communication are used by various specialty credentialing organizations and managed care organizations as a measure of physician communication skills. We wanted to compare ratings by real patients with ratings by standardized patients of physician communication. METHODS: We assessed physician communication using a modified version of the Health Care Climate Questionnaire (HCCQ) among a sample of 100 community physicians. The HCCQ measures physician autonomy support, a key dimension in patient-centered communication. For each physician, the questionnaire was completed by roughly 49 real patients and 2 unannounced standardized patients. Standardized patients portrayed 2 roles: gastroesophageal disorder reflux symptoms and poorly characterized chest pain with multiple unexplained symptoms. We compared the distribution, reliability, and physician rank derived from using real and standardized patients after adjusting for patient, physician, and standardized patient effects. RESULTS: There were real and standardized patient ratings for 96 of the 100 physicians. Compared with standardized patient scores, real-patient-derived HCCQ scores were higher (mean 22.0 vs 17.2), standard deviations were lower (3.1 vs 4.9), and ranges were similar (both 5-25). Calculated real patient reliability, given 49 ratings per physician, was 0.78 (95% confidence interval [CI], 0.71-0.84) compared with the standardized patient reliability of 0.57 (95% CI, 0.39-0.73), given 2 ratings per physician. Spearman rank correlation between mean real patient and standardized patient scores was positive but small to moderate in magnitude, 0.28. CONCLUSION: Real patient and standardized patient ratings of physician communication style differ substantially and appear to provide different information about physicians' communication style.

Original languageEnglish (US)
Pages (from-to)151-158
Number of pages8
JournalAnnals of Family Medicine
Volume5
Issue number2
DOIs
StatePublished - Mar 2007

Fingerprint

Communication
Physicians
Climate
Delivery of Health Care
Organizations
Confidence Intervals
Credentialing
Managed Care Programs
Gastroesophageal Reflux
Chest Pain

Keywords

  • Clinical competence
  • Patient simulation
  • Physician-patient relations
  • Reproducibility of results

ASJC Scopus subject areas

  • Family Practice

Cite this

Ratings of physician communication by real and standardized patients. / Fiscella, Kevin; Franks, Peter; Srinivasan, Malathi; Kravitz, Richard L; Epstein, Ronald.

In: Annals of Family Medicine, Vol. 5, No. 2, 03.2007, p. 151-158.

Research output: Contribution to journalArticle

@article{b555cf6c33b14b178941b9a7b0ac3dd0,
title = "Ratings of physician communication by real and standardized patients",
abstract = "PURPOSE: Patient ratings of physician's patient-centered communication are used by various specialty credentialing organizations and managed care organizations as a measure of physician communication skills. We wanted to compare ratings by real patients with ratings by standardized patients of physician communication. METHODS: We assessed physician communication using a modified version of the Health Care Climate Questionnaire (HCCQ) among a sample of 100 community physicians. The HCCQ measures physician autonomy support, a key dimension in patient-centered communication. For each physician, the questionnaire was completed by roughly 49 real patients and 2 unannounced standardized patients. Standardized patients portrayed 2 roles: gastroesophageal disorder reflux symptoms and poorly characterized chest pain with multiple unexplained symptoms. We compared the distribution, reliability, and physician rank derived from using real and standardized patients after adjusting for patient, physician, and standardized patient effects. RESULTS: There were real and standardized patient ratings for 96 of the 100 physicians. Compared with standardized patient scores, real-patient-derived HCCQ scores were higher (mean 22.0 vs 17.2), standard deviations were lower (3.1 vs 4.9), and ranges were similar (both 5-25). Calculated real patient reliability, given 49 ratings per physician, was 0.78 (95{\%} confidence interval [CI], 0.71-0.84) compared with the standardized patient reliability of 0.57 (95{\%} CI, 0.39-0.73), given 2 ratings per physician. Spearman rank correlation between mean real patient and standardized patient scores was positive but small to moderate in magnitude, 0.28. CONCLUSION: Real patient and standardized patient ratings of physician communication style differ substantially and appear to provide different information about physicians' communication style.",
keywords = "Clinical competence, Patient simulation, Physician-patient relations, Reproducibility of results",
author = "Kevin Fiscella and Peter Franks and Malathi Srinivasan and Kravitz, {Richard L} and Ronald Epstein",
year = "2007",
month = "3",
doi = "10.1370/afm.643",
language = "English (US)",
volume = "5",
pages = "151--158",
journal = "Annals of Family Medicine",
issn = "1544-1709",
publisher = "Annals of Family Medicine, Inc",
number = "2",

}

TY - JOUR

T1 - Ratings of physician communication by real and standardized patients

AU - Fiscella, Kevin

AU - Franks, Peter

AU - Srinivasan, Malathi

AU - Kravitz, Richard L

AU - Epstein, Ronald

PY - 2007/3

Y1 - 2007/3

N2 - PURPOSE: Patient ratings of physician's patient-centered communication are used by various specialty credentialing organizations and managed care organizations as a measure of physician communication skills. We wanted to compare ratings by real patients with ratings by standardized patients of physician communication. METHODS: We assessed physician communication using a modified version of the Health Care Climate Questionnaire (HCCQ) among a sample of 100 community physicians. The HCCQ measures physician autonomy support, a key dimension in patient-centered communication. For each physician, the questionnaire was completed by roughly 49 real patients and 2 unannounced standardized patients. Standardized patients portrayed 2 roles: gastroesophageal disorder reflux symptoms and poorly characterized chest pain with multiple unexplained symptoms. We compared the distribution, reliability, and physician rank derived from using real and standardized patients after adjusting for patient, physician, and standardized patient effects. RESULTS: There were real and standardized patient ratings for 96 of the 100 physicians. Compared with standardized patient scores, real-patient-derived HCCQ scores were higher (mean 22.0 vs 17.2), standard deviations were lower (3.1 vs 4.9), and ranges were similar (both 5-25). Calculated real patient reliability, given 49 ratings per physician, was 0.78 (95% confidence interval [CI], 0.71-0.84) compared with the standardized patient reliability of 0.57 (95% CI, 0.39-0.73), given 2 ratings per physician. Spearman rank correlation between mean real patient and standardized patient scores was positive but small to moderate in magnitude, 0.28. CONCLUSION: Real patient and standardized patient ratings of physician communication style differ substantially and appear to provide different information about physicians' communication style.

AB - PURPOSE: Patient ratings of physician's patient-centered communication are used by various specialty credentialing organizations and managed care organizations as a measure of physician communication skills. We wanted to compare ratings by real patients with ratings by standardized patients of physician communication. METHODS: We assessed physician communication using a modified version of the Health Care Climate Questionnaire (HCCQ) among a sample of 100 community physicians. The HCCQ measures physician autonomy support, a key dimension in patient-centered communication. For each physician, the questionnaire was completed by roughly 49 real patients and 2 unannounced standardized patients. Standardized patients portrayed 2 roles: gastroesophageal disorder reflux symptoms and poorly characterized chest pain with multiple unexplained symptoms. We compared the distribution, reliability, and physician rank derived from using real and standardized patients after adjusting for patient, physician, and standardized patient effects. RESULTS: There were real and standardized patient ratings for 96 of the 100 physicians. Compared with standardized patient scores, real-patient-derived HCCQ scores were higher (mean 22.0 vs 17.2), standard deviations were lower (3.1 vs 4.9), and ranges were similar (both 5-25). Calculated real patient reliability, given 49 ratings per physician, was 0.78 (95% confidence interval [CI], 0.71-0.84) compared with the standardized patient reliability of 0.57 (95% CI, 0.39-0.73), given 2 ratings per physician. Spearman rank correlation between mean real patient and standardized patient scores was positive but small to moderate in magnitude, 0.28. CONCLUSION: Real patient and standardized patient ratings of physician communication style differ substantially and appear to provide different information about physicians' communication style.

KW - Clinical competence

KW - Patient simulation

KW - Physician-patient relations

KW - Reproducibility of results

UR - http://www.scopus.com/inward/record.url?scp=34047134247&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34047134247&partnerID=8YFLogxK

U2 - 10.1370/afm.643

DO - 10.1370/afm.643

M3 - Article

C2 - 17389540

AN - SCOPUS:34047134247

VL - 5

SP - 151

EP - 158

JO - Annals of Family Medicine

JF - Annals of Family Medicine

SN - 1544-1709

IS - 2

ER -