The practice orientations of physicians and patients: the effect of doctor–patient congruence on satisfaction
Introduction
The doctor–patient relationship is a product of the attitudes and orientations that the two participants bring to it. In recent years much attention has been directed to studying the varying orientations of physicians toward their patients, in particular the distinction between a patient-oriented style versus a disease- or doctor-oriented style of interaction [1], [2], [3]. Other researchers, working in parallel, have focused on patients’ orientations toward their providers, noting in particular that some patients prefer a more participatory style of interaction [4], [5]. Yet, there has been little relationship-focused research that simultaneously addresses the orientations, preferences, and styles of both parties. The present research brings these parallel lines of research together by investigating the extent to which patients’ satisfaction with their primary care physicians is a function of the patient’s orientation, the physician’s orientation, and the degree of congruence between the two.
Physicians exhibit differing styles of interaction with their patients from ‘doctor-centered’ (or ‘disease-oriented’) at one extreme to ‘patient-centered’ at the other [6], [7], [8], [9], [10]. The former embodies the classic paternalistic doctor–patient relationship in which the physician is relatively dominant, the medical problem is the central concern, and the patient is expected to defer to the physician’s judgement. The latter is characterized by the practitioner’s desire for a relationship in which the patient is involved in decision making, and the ‘person’ rather than the ‘medical problem’ is the focus of treatment.
Patients also differ in their preferences and interaction styles. For instance, many older patients prefer a relationship that is doctor-centered, desiring little information and leaving decision-making to their physicians [11], [12]. In contrast, a growing number of patients have adopted a consumerist stance, seeking as much information as possible and using their physicians as consultants or advisors to present them with options from which to select [13], [14].
Anecdotal evidence about the congruence or fit between doctor and patient attitudes is plentiful, but little empirical research about congruence and its consequences has been conducted [15], [16], [17], [18], [19]. In this study, we have measured the practice orientations of physicians and their patients using the Patient–Practitioner Orientation Scale (PPOS), a paper-and-pencil instrument in which physicians and their patients respond to identical statements about the roles that each should play in medical encounters [20], [21]. Because both physician and patient answer identical questions, their scores can be compared directly, and congruence can be calculated as a discrepancy score. Patient satisfaction can therefore be assessed as a function of the individual orientations of the physician and the patient, but the doctor–patient pair can also be used as the unit of analysis to investigate the role of congruence. This study tests two hypotheses: (1) patients are more satisfied with patient-centered physicians than doctor-centered physicians, and (2) patients are more satisfied with physicians whose orientations are congruent with theirs than those whose are not (regardless of the individual orientations of the physicians or the patients).
Section snippets
Methods
The study was conducted in two phases. The goal of the first phase was to identify 60 primary care physicians whose practice attitudes varied from patient-centered to doctor-centered as measured by the PPOS. In the second phase, patients from the practices of these physicians were asked to fill out the PPOS and to indicate their satisfaction with their physicians.
Characteristics of the samples
Table 1, which presents the characteristics of those physicians (n=177) who provided usable data for Phase 1 and the sub-set of physicians (n=60) whose patients were selected for Phase 2, shows that the 60 physicians chosen were representative of the larger sample of respondents. A total of 670 patients returned their questionnaires (return rate=67%). Respondents were eliminated if they did not fully answer the PPOS and PSQ measures, if they had not had at least one visit with the physician, or
Discussion
This study asks what personal characteristics are related to patient-centeredness among physicians and patients, and then addresses two main questions: (1) Is a patient centered orientation among doctors associated with greater patient satisfaction? and (2) Does congruence of orientations contribute to satisfaction in doctor–patient pairs?
The findings of this study are consistent with the literature on patient-centeredness among patients. Patients who are younger, better educated, and female
Practice implications
Although the data collected in this survey do not allow this last explanation to be tested, the implications of this interpretation are important. If patient-centeredness translates to a pleasing style of interaction, a ‘one-size fits all’ approach to patient relations, then the key components of that style ought to be identified, taught, and reinforced among all medical practitioners. If, however, a patient-centered orientation translates into adaptability to patient needs, educators do not
Acknowledgements
This research was funded by a grant from the Harvard Pilgrim Health Care Foundation.
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