Duberstein Paul, Meldrum Sean, Fiscella Kevin, Shields Cleveland G, Epstein Ronald M
Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA.
Patient Educ Couns. 2007 Feb;65(2):270-4. doi: 10.1016/j.pec.2006.09.007. Epub 2006 Nov 27.
There is considerable interest in the influences on patients' ratings of physicians.
In this cross-sectional study, patients (n = 4616; age range: 18-65 years) rated their level of satisfaction with their primary care physicians (n = 96). Patients and physicians were recruited from primary care practices in the Rochester, NY metropolitan area. For analytic purposes, length of the patient-physician relationship was stratified (< or =1, 1-4, > or =5 years). Principal components factor analysis of items from the Health Care Climate Questionnaire, the Primary Care Assessment Survey and the Patient Satisfaction Questionnaire yielded a single factor labeled "Satisfaction" that served as the sole dependent variable. Higher scores mean greater satisfaction. Predictors of interest were patient demographics and morbidity as well as physician demographics and personality, assessed with items from the NEO-FFI.
Patients treated by a physician for 1 year or less rated male physicians higher than female physicians. This gender difference disappeared after 1 year, but two physician personality traits, Openness and Conscientiousness, were associated with patients' ratings in lengthier patient-physician relationships. Patients report being more satisfied with physicians who are relatively high in Openness and average in Conscientiousness. Older patients provide higher ratings than younger patients, and those with greater medical burden rated their physicians higher.
Patients' ratings of physicians are multidetermined. Future research on patient satisfaction and the doctor-patient relationship would benefit from a consideration of physician personality. Identifying physician personality traits that facilitate or undermine communication, trust, patient-centeredness, and patient adherence to prescribed treatments is an important priority.
Learning environments could be created to reinforce certain traits and corresponding habits of mind that enhance patient satisfaction. Such a shift in the culture of medical education and practice could have implications for patient care.
人们对影响患者对医生评分的因素极为关注。
在这项横断面研究中,患者(n = 4616;年龄范围:18 - 65岁)对其初级保健医生(n = 96)的满意度进行评分。患者和医生均来自纽约州罗切斯特市大都市地区的初级保健机构。为便于分析,将患者与医生的关系时长分为不同层次(≤1年、1 - 4年、≥5年)。对来自《医疗保健氛围问卷》《初级保健评估调查》和《患者满意度问卷》的项目进行主成分因子分析,得出一个名为“满意度”的单一因子,作为唯一的因变量。得分越高表明满意度越高。感兴趣的预测因素包括患者的人口统计学特征和发病率,以及医生的人口统计学特征和性格,通过《大五人格量表简式版》中的项目进行评估。
由医生治疗1年及以下的患者对男医生的评分高于女医生。这种性别差异在1年后消失,但在更长的医患关系中,医生的两种人格特质,即开放性和尽责性,与患者评分相关。患者报告称,对开放性较高且尽责性中等的医生更满意。老年患者的评分高于年轻患者,医疗负担较重的患者对医生的评分更高。
患者对医生的评分是由多种因素决定的。未来关于患者满意度和医患关系的研究若能考虑医生的个性,将大有裨益。识别有助于或有损沟通、信任、以患者为中心以及患者对规定治疗的依从性的医生个性特质是一项重要的优先事项。
可以营造学习环境,强化某些能提高患者满意度的特质和相应的思维习惯。医学教育和实践文化的这种转变可能会对患者护理产生影响。