CHATTING BEHAVIOR AND PATIENT SATISFACTION: DISCUSSION
The purpose of this study was to examine the interaction between chatting behavior and patient sociodemographic factors and patient satisfaction. Our work may be best placed in light of the DOPC study. We found that chatting was less prevalent than previously reported from the DOPC (61% vs. 69%) and there are two plausible reasons for this discrepancy. First, a difference in the methodology used to report chatting behavior could account for prevalence differences. The DOPC used a combination of direct observation of patient visits, patient exit questionnaires, and medical record reviews, while our study relied upon exit surveys as the sole means of data collection. This difference may account for an under-reporting of chatting behavior in our study, however, we were interested in the patient perspective of chatting during the encounter.
A second reason may be differences between the DOPC and our study population. The DOPC enrolled predominantly suburban and rural practice sites (81.9%), while our practice site was located in an urban setting. Practice site may account for considerable variation among patient demographic variables, which may be a significant factor associated with the proportion of the visit time spent chatting. This assumption is consistent with the racial differences in the sociodemographics of our study population, which had a larger percentage of nonwhite participants (48%) compared to the DOPC (12%). These methodological differences may account for the discrepancy in our finding of no association of chatting behavior with satisfaction with length of time spent with the physician, with that of the DOPC, which found an association. The lack of statistical power to detect a significant difference in satisfaction scores, due to a modest sample size in our study, could be another reason. Apcalis Oral Jelly
The DOPC, however, limited its outcome variable to this one domain from the VRQ. We examined other VRQ outcome measures of patient satisfaction with their provider but did not find any significant association of chatting behavior with any domains, such as personal manner or visit explanation. In addition, although the DOPC reported only the prevalence of chatting behavior, we sought to determine the content areas of the behavior and to determine if there was an association of specific chatting topics (e.g., discussing patient family or friends) with patient satisfaction. We found no association between VRQ patient satisfaction measures and eight patient-identified chatting topics.
Chatting about patient family or friends was the predominant topic, and nonwhite patients were more likely to report this topic than white patients. There are a few hypotheses for this finding. Non-white patients may interpret questions and discussions about family or friends as a chatting behavior, rather than social or family history data gathering activity, perhaps due to language barriers or patient-provider race discordance. The presence of another family member, either as interpreter or cultural broker, may be more prevalent in nonwhite encounters, prompting a chatting discussion. However, patient visits in which another family member’s problem is discussed are longer, yet less time in that encounter is spent chatting.
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How should clinicians interpret and utilize these findings, since chatting has been recommended as a way to enhance patient satisfaction? Physicians should initially recognize that all patients bring a set of silent and spoken expectations and assumptions to the medical encounter. Patient characteristics, such as age, race/ethnicity, and health status, impact these expectations and are also strongly predictive of satisfaction. Although many of these characteristics are not amenable to physician intervention, clinicians may potentially impact two modifiable factors—chatting behavior and visit length—in a more global or relationship-centered fashion. Patients in our study overwhelmingly identified topics that were personally specific (e.g., family, friends) rather than more general topics (e.g., news events). Perhaps chatting and visit duration may be viewed as key facilitators to the physician’s understanding of the patient experience of health and illness. If this assumption is correct, chatting should be considered a more-inclusive part of history-taking and family information gathering rather than a task that is independent of these processes.
There were several limitations to our study. Our convenience sample comprised patients from one urban setting in the midwest, and our findings are not generalizable to other populations. In addition, our sample size may have been inadequate to completely stratify by sociodemographic factors, and may have not been sufficiently powered to detect a significant difference in satisfaction scores. Final ly, although we utilized items from an established measure of patient satisfaction, this instrument has reported ceiling effects. canadian cialis online
In summary, we employed a standard methodology to assess patient satisfaction in clinical practice and found a high prevalence of patient-reported chatting behavior in an urban family practice, but no association of chatting with patient sociodemographic factors or patient satisfaction. Future research on the communication within the medical encounter should delineate the processes and outcomes of physician chatting behavior as a potential facilitator of patient-centered care.
