The impact of communication between physician and patient on the outpatient service

Healthcare Quality:
(The impact of communication between physician and patient on the outpatient
Good communication between a physician and a patient is necessary for the
former to  understand  and  appropriately  treat  a problem  that  brings the  latter to  the
hospital.  The  physician-patient  communication  includes  information  exchanging,
assisting  patients in  self-management  of  their  conditions,  managing uncertainty  and
emotions,  making  decisions,  and  improving  the  physician-patient  relationship.
Moreover,  adequate  physician-patient  communication  has  been  linked  to  positive
health  outcomes.  The  purpose  of  this  research  is  to  explain  the  impact  of
communication  between  physician  and  patient  on  the  outpatient  service  and
healthcare quality in general.
Literature Review
A literature search was carried out using two separate databases: PubMed and
Google Scholar. The key terms ‘quality impact’ or ‘outcome’ were explored together
with  ‘physician  and  patient  communication’ or  ‘outpatient  communication.’ After
collecting  all  the  relevant  publications,  every  book/article  was read  thoroughly  to
obtain its contents. The main ideas are presented below.
Effective  communication  between  a  doctor  and  a  patient  can  assist  in
improving  the latter’  emotions,  understanding  of  medical  information,  and getting
information on patients’  requirements,  perceptions,  and  expectations.  Patients  who
consider  their  communication  with  physicians  as  effective  are  more  likely  to  be
contented with their outpatient visits, willingly share relevant information for proper
diagnosis  of  their  conditions, and adhere  to  advice  and  treatment  (Arora,  2003;
Stewart,  1995).  The  concurrence  of  patients  and  physicians  about  the  type  of
treatment and the need for follow-up is closely associated with the recovery process
(Stewart, Brown, & Donner, 2000).  Moreover, productive communication has been
shown to have a strong connection with a sense of control and ability to tolerate pain
among  patients  suffering  from  chronic  conditions.  Patients  having  good
communication with their doctors also exhibited psychological adjustment and better
mental  health.  Little  et  al.  (2001)  found  that  effective  communication  between
physicians and patients also leads to lower cost of individual medical visits and fewer
Various studies also link physician-patient communication to adherence levels
among patients. Zolnierek and DiMatteo (2009) carried a meta-analysis on physicianpatient  communication  and  found  that  there  is  a  strong  correlation  with  patient
adherence.  A  Health Care  Quality  Survey  conducted by  the  Commonwealth Fund
established  that  25%  of  Americans  did  not  adhere  to  their  physicians’
recommendations (Davis et al., 2002). The survey found that 39% differed with the
recommendations of a medical practitioner, 27% could not adhere because of the cost,
20% stated  that  the  recommendation  was  against  their  personal  beliefs,  while  7%
asserted  that  they  did  not  comprehend  the  instructions.  Effective  physician-patient
communication would eliminate such high levels of non-adherence to the instructions.
It was also concluded that there were increases in adherence when doctors obtained
communication training.
Various  studies  have  focused  on  the influence  of  physician-patient
communication on health outcomes in inpatient services. However, this paper sought
to find the impact of communication between physician and patients on the outpatient
services.  It  hypothesizes  that  physician-patient  communication  leads  to  higher
adherence levels, more patient satisfaction, better physical and mental health, seeking
of preventive services, and more satisfied physicians.
Adherence refers to the degree to which a patient’s behavior matches with the
recommendations from a doctor. Excellent physician-patient communication will lead
to higher adherence levels in the outpatient service. This is because good physician
and  patient  communication results  in  a  patient  assuming  a  more  active  and
participatory  role  in  decision-making because  he  or  she trusts a doctor.  The  two
reasons increase the patient ability to adhere to the physicians’ recommendations in
outpatient  care  settings.  Negative  patient  attitudes  towards  physicians  are  highly
linked to non-adherence, although the existence of side effects from the medications
or their costs also adds to the problem. Conversely, better communication results in
improved  understanding  by  the  patient  of  the  condition  processes  that  require
treatment,  the  intended  goals  of  the  treatment,  potential  side  effects,  and  how  and
when  the  treatment  should  be  undertaken.  The  cost  of  medication  also  affects
Better Health, Functional, and Emotional Status
Effective physician-patient communication has a positive effect on the health,
functional, and emotional status of the patient. Roter et al. (1997) carried a study that
examined  the  effects  of  communication  skills  training  on  the  process  and  result  of
patient  care;  it  found that  effective  communication  lead  to  decreased  emotional
distress in patients. On the other hand, Stewart et al. (1995) conducted a review of
twenty-one studies that examined the effects of physician-patient communication on
patient health results and found that the quality of communication and dialogue on the
management  plan result  in an  improved  health  outcome. They also revealed that
effective  communication is  linked  to  the  better  management  of  chronic  conditions
such  as  blood  pressure  and  pain  control.  Therefore,  there  will  be  better  health,
functional, and emotional status of patients in outpatient services when there is a good
physician-patient communication.
Enhanced Physician Satisfaction
Good communication  between  doctors and  patients is  also  associated  with
improved physician satisfaction with their professional life. It is because the satisfied
physicians feel that they can attend to the concern of the patients. Grembowski et al.
(2005)  conducted  a  study  in  the  outpatient  department of  a  teaching  hospital  and
found that physicians’ satisfaction with their professional life was linked to patients’
high  trust  and  confidence  in  their  primary  care  physicians.  It  shows  that  satisfied
physicians are happier that they can deal with the concerns of patients. Such happy
doctors may also have better communication with patients, which in turn improves the
satisfaction levels of patients. Interestingly, patients cite physician satisfaction as one
of  the  main  factors  of  visiting  a  particular  hospital  (Victoor,  Delnoij,  Friele, &
Rademakers,  2012).  Therefore,  good  communication  between doctors and  patients
will result in the formers’ satisfaction in the outpatient service.
Improved Use of Preventive Medical Services
Good physician-patient connection  results  in  better  use  of  preventive  medical
services;  for  instance,  patients  will  be more  willing  to  use  cancer  screening.
Preventing care leads to better health and lower costs. Therefore, there will be more
use  of  preventive  medical  services  in  the  outpatient  service  when  there  is  good
communication between a physician and a patient.
Physical Health
Physical  health  status  includes  pain  and  other  symptoms,  disease  markers,
functional capacity, and subjective self-ratings of health. Outpatient treatment leads to
better physical health includes medication and behavioral regimens such as smoking
cessation  and  diet.  For  instance,  a  patient  may  experience  better  physical  health
because he or she obtained medication that controlled the disease, adopted healthier
exercises,  and  believed  the  treatment  was  effective,  which  will  be  the  result  of  the
followed  doctor’s  prescriptions.  Therefore,  the  communication  can result  in  better
health if the communication between a physician and a patient helped to identify the
correct diagnosis and suitable treatment plan.
Arora, N. K. (2003). Interacting with cancer patients: The significance of physicians’
communication behavior. Social Science &Medicine, 57(5), 791-806.
Davis, K., Schoenbaum, S. C., Collins, K. S., Tenney, K., Hughes, D. L., & Audet, A.
M.  J.  (2002). Room for improvement: Patients report on the quality of their
health  care. Washington,  DC: The  Commonwealth  Fund.  Retrieved  from
Grembowski,  D.,  Paschane,  D.,  Diehr,  P.,  Katon,  W.,  Martin,  D.,  &  Patrick,  D.  L.
(2005). Managed care, physician job satisfaction, and the quality of primary
care. Journal of General Internal Medicine, 20(3), 271-277.
Little, P., Everitt, H., Williamson, I., Warner, G., Moore, M., Gould, C., … & Payne,
S.  (2001).  Observational  study  of  effect  of  patient  centredness  and  positive
approach on outcomes of general practice consultations. Bmj, 323(7318), 908-911.
Roter, D. L., Steward, M., Putnam, S. M., Lipkin, M., Jr., Stitles, W., & Inui, T. S.
(1997). Communication  patterns  of  primary  care  physicians. Journal  of  the
American Medical Association, 277(4), 350-356.
Stewart,  M.  A.  (1995).  Effective  physician-patient  communication  and  health
outcomes:  A review. Canadian  Medical  Association  Journal, 152(9),  1423-1433.
Stewart, M., Brown J. B., Donner A., McWhinney, I. R., Oates, J., Weston, W. W., &
Jordan, J. (2000). The impact of patient-centered care on outcomes. Journal of
Family Practice, 49(9), 796–804


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