SLR - May 2019 - Dylan A. Grau
Reference: Kortlever JT, Ottenhoff JS, Vagner GA, Ring D, Reichel LM. Visit Duration Does Not Correlate with Perceived Physician Empathy. J Bone Joint Surg Am. 2019 Feb 20; 101 (4), 296–301.Scientific Literature Review
Reviewed By: Dylan A. Grau, DPM
Residency Program: Truman Medical Center Lakewood, Kansas City, MO
Podiatric Relevance: The healthcare industry has become more focused on patient-centered healthcare. Using quality metrics, such as patient-reported satisfaction, has gained popularity to measure the quality of care a physician has performed. Many hospital systems are now using similar models to incentivize physicians for positive patient outcomes/interactions. While this has become important, hospitals have also pressured physicians into increasing patient load to ensure maximum profit. This article demonstrates the importance of effective communication skills with patients to optimize patient-perceived outcomes.
Methods: A prospective, cross-sectional, observational cohort study between October 2017 and November 2017. The Jefferson Scale of Patient’s Perceptions of Physician Empathy (JSPPPE) questionnaire was given to all new or returning patients, which is a five-item questionnaire with score values measuring five to 35, higher scores indicating increased satisfaction. Physicians were asked to fill out the Perceived Stress Scale short form (PSS-4), which values range from 0 to 16, higher scores indicating increased perceived stress. Inclusion criteria was English-speaking, 18–89 years old, visiting one of six orthopaedic surgeons and able to provide consent. Other information tracked was difference between registration time and actual appointment time to evaluate if patients were on time. Also tracked was difference between registration time and when the surgeon entered the room for evaluation. All times were performed by independent research assistants not directly involved in the questionnaires.
Results: Of 114 patients screened, all met inclusion criteria. Patient mean age was 49 years, 49 percent were male and 49 percent had one or more comorbidities (cardiovascular disease, musculoskeletal disease, mental disease or other), 45 percent presented with traumatic condition and 77 percent were deemed to be on time for their appointments. Surgeon mean age was 45 years, 12 years in practice, PSS-4 was 8.5 and surgeon load ranged from 32–45 with an average of 37.5 patients. Mean wait time was 30 minutes, and mean time spent with the surgeon was 8.7 minutes. Using a multilevel linear regression model to evaluate significance (p <0.05), neither time spent with surgeon nor wait time were independently associated with perceived empathy. Less perceived empathy was associated with being male, at least postcollege graduate and higher surgeon stress level. More perceived empathy was associated with being African American.
Conclusions: The authors conclude that neither time spent with patients nor wait time was associated with perceived empathy. But rather sex, education and surgeon self-reported stress were more associated with patient’s perception of empathy. This suggests improving communication skills is more effective and important in perceived empathy and may increase overall patient satisfaction. The authors express a potential limitation in that only male surgeons were involved in this study, and this may alter some results, suggesting further research in this area would be of benefit.