Department of Psychology, University of Connecticut, Storrs, CT, USA.
Soc Sci Med. 2010 Mar;70(5):763-8. doi: 10.1016/j.socscimed.2009.10.065. Epub 2009 Dec 11.
Doctor-patient communication is an interpersonal process and essential to relationship-centered care. However, in many studies, doctors and patients are studied as if living in separate worlds. This study assessed whether: 1) doctors' perception of their communication skills is congruent with their patients' perception; and 2) patients of a specific doctor agree with each other about their doctor's communication skills. A cross-sectional study was conducted in three provinces in Canada with 91 doctors and their 1749 patients. Doctors and patients independently completed questions on the doctor's communication skills (content and process) after a consultation. Multilevel modeling provided an estimate of the patient and doctor variance components at both the dyad-level and the doctor-level. We computed correlations between patients' and doctors' perceptions at both levels to assess how congruent they were. Consensus among patients of a specific doctor was assessed using intraclass correlation coefficient (ICC). The mean score of the rating of doctor's skills according to patients was 4.58, and according to doctors was 4.37. The dyad-level variance for the patient was .38 and for the doctor was .06. The doctor-level variance for the patient ratings was .01 and for the doctor ratings, .18. The correlation between both the patients' and the doctors' skills' ratings scores at the dyad-level was weak. At the doctor-level, the correlation was not statistically significant. The ICC for patients' ratings was .03 and for the doctors' ratings .76. Overall, this study suggests that doctors and their patients have a very different perspective of the doctors' communication skills occurring during routine clinical encounters.
医患沟通是一种人际过程，对以关系为中心的护理至关重要。然而，在许多研究中，医生和患者被视为生活在两个不同的世界中。本研究评估了以下两个问题：1）医生对自己沟通技巧的看法是否与患者的看法一致；2）特定医生的患者是否对其医生的沟通技巧有一致的看法。本研究在加拿大的三个省份进行了一项横断面研究，共有 91 名医生及其 1749 名患者参与。在咨询后，医生和患者分别独立完成了关于医生沟通技巧（内容和过程）的问题。多层次模型提供了在对和医生水平上对患者和医生方差分量的估计。我们计算了患者和医生在两个层面上的看法之间的相关性，以评估它们的一致性。使用组内相关系数（ICC）评估特定医生的患者之间的一致性。根据患者的评分，医生技能的平均评分为 4.58，根据医生的评分为 4.37。患者的对水平方差为.38，医生的对水平方差为.06。患者评分的医生水平方差为.01，医生评分的医生水平方差为.18。对水平上，患者和医生的技能评分之间的相关性较弱。在医生水平上，相关性没有统计学意义。患者评分的 ICC 为.03，医生评分的 ICC 为.76。总体而言，这项研究表明，医生和患者对常规临床就诊中医生沟通技巧的看法非常不同。
