By Tammy Fisher, MPH

RESEARCH AND EXPERIENCE in California with 12 physician practices (nine primary care physicians, three sub-specialists) show that small changes in the way physicians interact with their patients can make a big difference in patients' experiences with their doctors. Making investments in patient-centered care - like using eye contact, empathic statements and involving patients in setting the agenda for their visit - have been shown to improve patient satisfaction, clinical outcomes (such as treatment adherence and physician satisfaction) and to reduce malpractice suits. 1,2,3

These changes may seem intuitive, yet adoption of them is slow, despite an increasing state and national focus on the importance of providing patient-centered care. As one of the Institute of Medicine aims, there is rapid movement towards measuring physician performance in aspects of patient-centered care like doctor-patient communication. We already see evidence of this in primary care. Demonstrating core competency in doctor-patient interpersonal skills, such as showing empathy and respect, are necessary for board certification requirements. In addition, the California pay-for-performance program has incorporated doctor-patient communication measures in its bonus programs for public reporting and payment at the physician organization level.

The California data tell us that there is room for improvement. Trends from the California Pay-for-Performance Initiative, which involves 6.2 million HMO commercial enrollees represented by 225 large physicians groups and about 35,000 physicians, suggest only modest statewide improvements in patient ratings of their doctors and overall care over time.

Between 2003 and 2005, a mere 2.7 percent change in overall rating of doctor and a 4.9 percent change in overall rating of care were observed. As consumer-driven health care continues to gain speed and competition for patients grows, it will become increasingly important for physicians to rise above the status quo and make significant improvements in the way they interact with their patients. Getting the right tools is the first step.

Techniques to Improve Doctor-Patient Interactions
Over the course of a year, 12 physician practices came together in the California improve doctor-patient interactions. High leverage changes identified in the literature and Collaborative shown to improve doctor-patient interactions are:

• Negotiate the agenda with the patient at the start of the visit;
• Make a personal connection and demonstrate empathy through eye contact and empathic statements; and,
• Provide closure by summarizing next steps and action plan.

Physicians engaged in the Collaborative and testing these changes showed statistically significant improvements in their patient satisfaction scores over baseline. Most increased performance in the overall rating of doctor measure by one to four points on a 10-point scale. This improvement is substantially relative to the modest improvements observed statewide. Physicians who participated in the Collaborative also reported increases in their own satisfaction with the practice. Remarkably, it was simple changes like those listed above that seemed to make a large impact. In addition, patients perceived their time with their physician longer than time actually spent with them which was important for busy, thriving primary care offices.

Get started with three quick techniques...

References:
1. Lewin SA, Skea ZC, Entwistle V, Zwarenstein M, Dick J. Interventions for providers to promote a patient-centered approach in clinical consultations. The Cochrane Database of Systematic Reviews. 2001; issue 4. (Clark 1998); (Pill, 1998)
2. Pathman et al., 2001; Suchman AL, Roter DL, Greene MG, et al. Physician satisfaction with primary care office visits. Medical Care. 1993; 31:1083-92
3. Stewart et. al., 2000. The impact of patient-centered care on outcomes. The Journal of Family Practice. 2000; 49(9): 796-804

Tammy Fisher, MPH is the co-director of the Pacific Business Group on Health's Patient Experience Collaborative.