PubMed · 9526384
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K Anderson. 1998. Creating a positive first impression.. https://doi.org/10.1097/00152193-199803000-00028
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BACKGROUND: The practice of medicine has many expected and accepted challenges, but all physicians experience some patients as difficult to a degree that transcends these expectations. Physician-experienced difficulty is associated with a syndrome of three characteristics: patient psychopathology, abrasive interpersonal styles, and multiple physical symptoms. OBJECTIVE: To assess the roles played by the number of physical symptoms and by specific symptoms in determining whether physician-experienced difficulty occurs. DESIGN: New analyses of epidemiologic survey data from the Primary Care Evaluation of Mental Disorders (PRIME-MD) 1000 Study. SETTING: Four primary care clinics. PARTICIPANTS: 627 ambulatory patients seen by 27 physicians. MEASUREMENTS: Physician-experienced difficulty was measured by using the 10-item Difficult Doctor Patient Relationship Questionnaire (DDPRQ-10); patient-reported physical symptoms and physician-assessed psychopathology and somatoform symptoms were evaluated by using the PRIME-MD; and physical illnesses were measured by using a physician questionnaire. RESULTS: The number of physical symptoms and the number of somatoform symptoms correlated with difficulty (r = 0.39 and r = 0.37, respectively; P < 0.001), and the correlations remained significant after adjustment for physical and mental disorders (r = 0.20 for both correlations; P < 0.001). Difficult patients were more likely to have each of 16 physical symptoms; the odds of being difficult were greater for patients with 1 of 5 particular symptoms (stomach pain, fainting, loose stools/diarrhea, palpitations, and sleep problems), even after adjustment for physical and mental disorders. All 10 items on the DDPRQ-10 were influenced by physical symptoms, particularly those items that asked about physician frustration and whether patients were manipulative and time consuming. CONCLUSIONS: The association between physical symptoms and difficulty is due in part to the association between physical symptoms and mental disorders, but symptoms also contribute independently to difficulty. The independent component of symptom-associated difficulty may be due to 1) differences between patient and physician in expectations about treatment and 2) the part that symptoms play in conferring the "sick role" on a patient.
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OBJECTIVE: To check the validity of content, the internal consistency and the intra-observer reliability of a questionnaire to evaluate the doctor-patient communication of family medicine residents. DESIGN: Observation study, to validate a measurement instrument. SETTING: Primary care. Family and community medicine teaching units. STUDY POPULATION: For the validity analysis: 25 family and community medicine residents. For the reliability analysis: 48 doctors in the same speciality. MEASUREMENTS AND INTERVENTIONS: The questionnaire was constructed on the basis of a version (GATHA-BASE) composed of 42 items selected by a panel of 60 general practitioners. For content validity, 68 clinical encounters with simulated patients, video-recorded and evaluated, were used. The questionnaire's validity content was studied through a factorial analysis. To measure its internal consistency, Cronbach's alpha coefficients were calculated. Intra-observer reliability of the GATHA-RES version was evaluated through the kappa indexes and the intra-class correlation coefficients. RESULTS: We obtained a version of the GATHA-RES with 27 items. The factorial analysis revealed that there were 9 factors (< >, < >, < >, < >, < >, < >, < > and < >) which showed close correlation with the theoretical and formal contents of the original questionnaire (originally grouped in three sections: attitudes, communication tasks and skills). All the intraclass correlation coefficients had figures > or = 0.90. CONCLUSIONS: The GATHA-RES questionnaire is a valid and reliable instrument that can be used for evaluating the communication skills of general practitioners in training.