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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 6
| Issue : 1 | Page : 30-35 |
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Patient–physician communication in health centers: A qualitative study
Mehran Alijanzadeh, Mohammadreza Maleki, Hamid Pourasghari
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| Date of Submission | 30-Aug-2022 |
| Date of Decision | 25-Dec-2022 |
| Date of Acceptance | 17-Jan-2023 |
| Date of Web Publication | 10-Feb-2023 |
Correspondence Address:
Mohammadreza Maleki
School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran
Iran
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/shb.shb_159_22
Introduction: A good relationship between physician and patient is effective in improving public health. The present study aimed to identify the factors affecting proper patient–physician communication in health centers. Methods: To this end, an exploratory qualitative study was conducted in 2019. The interviews were performed purposefully, and 18 patients referred to health centers were interviewed with maximum variation. The data were collected using semi-structured interviews and were analyzed using the approach of content analysis. Results: Data analysis revealed two main themes of human communication and health access. The theme of human communication consisted of four subthemes: physician's knowledge and experience, physician's behavior and ethics, comprehensive attention to the patient, and physician's discipline. Further, the theme of health access consisted of two subthemes: the physical condition of the center and the condition of the equipment. Conclusion: The identified components can be used to train medical students and evaluate the communication performance of doctors in health centers paying appropriate attention to these factors leading to patient satisfaction and, consequently, improving public health.
Keywords: Human communication, physician and patient, preventive care, qualitative study
How to cite this article:
Alijanzadeh M, Maleki M, Pourasghari H. Patient–physician communication in health centers: A qualitative study. Asian J Soc Health Behav 2023;6:30-5 |
| Introduction | |  |
Communication in the health system is defined as the creation and transfer of a message and, depending on the physician and patient as the sender and the receiver of the message can be achieved. Making an analogy with a circulatory system, it is stated that communication is a heart that transmits blood, i.e., information, to the health system.[1] Patient–physician communication is responsible for transmitting meaning between two individuals, which is highly important since it is associated with human health. Thus, the importance of investigating this issue in the health system is growing.[2] Positive physician–patient interaction has desirable effects on patient satisfaction and treatment outcome.[3] In this context, interpersonal communication between health-care providers is the influential factor in the satisfaction of patients with health systems.[4]
Rosenstein's study indicated that inappropriate interactions cause stress, frustration, reduced information transfer, reduced cooperation and disruption of proper communication, and declining quality of health-based care.[5] There is strong evidence that patient–physician communication is a good predictor of adherence to treatment instructions, implementation of diet therapy, and patient satisfaction.[6] In this context, the analyses showed that appropriate and proper communication between physician and patient can result in the formation of spiritual considerations, emotional response, participation attraction, interactive training, and proper counseling to promote the patient's health.[7]
Moreover, the physician's communication behavior with the patient is an important component of mutual interactions; patients with a better understanding of their physicians are more likely to express their problems, and hence, this leads to change in the patient's behavior and adherence to the physician's treatment instructions by the patient.[8] Some studies have shown the positive effect of the quality of patient–physician communication on patient care achievements, adherence to physician's instructions, reducing the required time to justify the patient and complaints from physicians, as well as patient satisfaction with the service provider.[9] The results of Feng Ha et al.'s study showed that patient complaints and dissatisfaction most commonly resulted from the failure of proper patient–physician communication; thus, proper communication between physician and patient will lead to the collection of proper information for diagnosis and treatment, influencing the effectiveness and efficiency of treatment.[10]
The present exploratory qualitative study aimed to identify the fundamental factors affecting patient–physician communication in health centers for patient motivation. Continuous visits to health centers to receive preventive and screening services is one of the points that has not been paid much attention to, hence the present study seeks to find important components in line with improving physician–patient communication to improve people's motivation to receive health services.
| Methods | | |
The present study was an exploratory qualitative design in 2019 which is mainly used for problems that are not properly described.[11] In addition, a qualitative study is required to precisely define a phenomenon and identify the contributing factors.[12] This study aimed to identify the effective factors in patient–physician communication. The group under study were the patients referred to health centers in Tehran. Through a preliminary review of the literature in this regard, the variables that can affect people's experiences were presented. The participants were asked about the factors leading to good patient–physician communication to keep this relationship and improve public health and result in service recipients' satisfaction.
The participants included 18 patients referred to the health centers of the Iran University of Medical Sciences in Tehran. An attempt was made to consider the maximum variation in the samples considering factors such as age, gender, education level, employment status, and marital status to gain a deeper understanding of the phenomenon under study as well as a wide range of information from individual experiences. Sampling continued until data saturation and two more samples were interviewed after reaching saturation to achieve higher accuracy. No new information was found in the interviews with participants 17 and 18. Semi-structured interviews were used to collect qualitative data. The interviews were focused on the main topic to obtain better results. The interviews were conducted in a silent place with a mean duration of 33 min (range: 20–46 min). The interviews were recorded by a recording device, analyzed, and coded before conducting the next one. Probe questions were used to gain more exact information on patient–physician communication. To increase the accuracy of the study, the findings of the study were confirmed by the participants and the results were reviewed by a colleague.
Data analysis
A content analysis approach was used to analyze data[13] to obtain meaning units and codes. To increase the conformability of the study, two authors examined the interviews precisely and discussed the meaning of units and codes until reaching a consensus.[14] MAXQDA V.10 was used to manage and analyze data. All the participants participated voluntarily in this study. The objectives of the study were explained to the participants. The participants were assured of the confidentiality of their information and signed the written informed consent.
Ethical consideration
This research project was approved by the Ethics Committee of the Iran University of Medical Sciences in Tehran with the ethics code of IR. IUMS. REC.1397.655 and Project Code of IUMS/SHMIS-97-3-37-13177.
| Results | | |
A total of 18 patients participated in this study, who were mostly females (n = 11). The participants' age ranged between 19 and 56 years. Most of the participants had an education level of elementary school (n = 6). The detailed demographic characteristics of the participants are presented in [Table 1].
The findings of the present study revealed two main themes of human communication and health access. Each theme comprised several subthemes, with several meaning units. [Table 2] briefly presents the results of themes, subthemes, and meaning units.
Human communication
The subthemes of physicians' knowledge and experience, comprehensive attention to the patients, the physician's behavior and ethics, and discipline were identified as the components of the human communication theme.
Physician's knowledge and experience
According to most participants in the study, the physician's knowledge and experience were essential factors that can lead to the physician's acceptance by the patient. The physician's sufficient medical experience and up-to-date information can be very helpful for the patient. Knowledge and experience help the physician make the right decisions and guide the patient more realistically.
“I may have a question and the physician is expected to answer and justify me. To me, the physician's knowledge and experience are very important. I accidentally saw the doctor's medical certificate and the university he graduated from when I entered the office. A doctor's experience is very important. However, experience is not easily recognized, but it is demonstrated in how the doctor deals with the patient's problem and makes the right decision.“
Comprehensive attention to the patient
To all the participants of this study, this factor was the most essential aspect of patient-physician communication. The majority of patients were very satisfied that the doctor paid attention to them. They asked the doctor to pay attention to what they were talking about and do their best to solve the patients' problems. Proper examination and justification of patients regarding their health condition can improve patient–physician communication.
“When I visit a doctor, I expect him/her to listen to me and be careful in the examination and not hurry in visiting me. First, I expect him/her to understand me and justify me and be responsible to me.“
Physician's behavior and ethics
Physician behavior and ethics were other important factors in patient–physician communication, which were vital to the patients. It was important to the patients that the physician gives them a sense of calmness and respect them. The physician's compassionate and proper behavior with the patient resulted in the patient's satisfaction and motivated them to keep their communication with the physician and visit the physician again if needed.
“When I visit a doctor, I expect him/her to listen to me. I used to visit a doctor who was very bad-tempered and told me I asked her too many questions. Hence, I left her office and told my mother this doctor was nervous and I couldn't talk to her. I would never go to her office again. Now, I go to another doctor, she is good-tempered and kind. I feel calm when I talk to her.“
Discipline
It was important for the patients that the physician was at work regularly and on time. The physician was expected to be present at work all the time. From the patients' perspectives, the regular presence of the physician at work indicated that the physician respects the patients.
“When I'm going to visit a doctor, it's very important to me that she/he is present at work and doesn't justify his/her absence with different excuses.“
Health access
Physical conditions of the health system and the equipment of the health center were the two subthemes identified as the components of the health access theme.
Physical conditions of the health center
The majority of the participants of the present study stated that the physical conditions of the health center affected patient–physician communication. They believed that one of the important issues in this regard was easy to access to the health center. They expected a convenient waiting room and reasonable waiting time to visit the physician and they expressed that they may quit or not refer again if they have to wait too long.
“Time is very important to me because you have an appointment when you go to visit a doctor, but the same time is set for all patients; for example, 10 o'clock. When you go to the office, you find there very crowded and have to wait too long to visit the doctor. They give appointments like hairdressers.“
Equipment of the health center
The center's equipment was one of the important factors to the participants of the present study. The patients believed that the center's equipment must be safe and sound to help the physician with the correct diagnosis. Another important factor, according to the patients, was the good cooling and heating facilities. They believed that the facilities they requested were the minimum requirements for a health center.
“When I am waiting to visit the doctor, the cold or the heat of the environment will affect me and I will be bored. If there is no empty chair in the waiting room to sit, I will be tired and upset. I may not be able to talk to the doctor after dealing with such problems.“
| Discussion | | |
The present study aimed to identify the factors affecting patient–physician communication. The results revealed two main themes, i.e., human communication, and health access, which had six subthemes. The human communication theme consisted of four subthemes, physician's knowledge and experience, comprehensive attention to the physician, physician's behavior and ethics, and physician's discipline.
The subtheme of a physician's knowledge and experience was one of the important factors in patient–physician communication. This factor comprised the physician's correct diagnosis, making the right decision for the patient, and providing correct answers to the patients. Moreover, it was found that directing the patients to improve their health was one of the subsets of this factor. The results of a study showed that physicians do not involve the patients in their decisions and leave the patients' questions unanswered, leading to conflict between patient and physician.[15] The results of another study indicated that the patients, the physicians who spend more time listening to the patients' explanations and answering their questions, and describing the patients' conditions in simple language were more expected.[16],[17]
Another important factor of patient–physician communication was comprehensive attention to the patient. Patients could communicate better with the doctor when they found the physician cared and paid attention to them. The patients wanted the doctor to pay attention to what they were explaining and do their best to solve the patients' problems. They also wanted the doctor to be careful while examining the patient and spend enough time.[18] Therefore, the evaluation of medical care is essentially associated with the evaluation of the patient of the physician's behavior and ability to communicate with patients.[19] Zhong et al. showed that the physician's behavior toward a patient needs special attention, and this fundamental principle should always be considered.[20]
The other factor was the physician's behavior and ethics, which comprised intimacy and empathy with patients, understanding the patient's conditions, gaining the patient's trust, giving a sense of calmness to the patient, respecting the patients, and other similar issues. From the patient's perspective, this factor was the most important in patient–physician communication. The results of a study conducted on physicians' behavior and ethics showed that the physicians' destructive behaviors and lack of proper communication with patients are observed in 57% of the physicians, affecting the effectiveness of communication.[21] Another study found that the physician's attention to the patient strongly affected the proper communication between the patient and physician.[22] The results of a similar study showed that helping the patient, gaining the patient's trust, understanding the patient's condition, using the right tone of language by the physician, and making sense of calmness in the patient were effective factors, among others, in the patient-physician communication which positively affected the patient's satisfaction.[23]
The last factor of the theme of human communication was the physician's discipline which was considered an important factor in the perspectives of the participants in the present study. The patients reacted to the physician's delay or absence on some days and considered it unacceptable and unjustifiable. They expected the physician to respect and value them by being present on time in the workplace.
The theme of health access included two subthemes of physical conditions of the health center and the equipment of the health center. It included different issues such as an appropriate waiting room, easy access to the center, the logical and reasonable waiting time to receive service, having good facilities to examine the patient in the center, the existence of required equipment, proper cooling, and heating facilities in the health center. Another study has shown that the center's physical conditions and equipment, and facilities affect the patient's satisfaction with the service provider and ultimately affect patient-physician communication.[24] In addition, another study indicated that easy access to the health center affects the patients' use of primary health care services.[25] Edes et al.'s study revealed the effectiveness of access to service on the patient's referral to the health centers for services.[26] It has also been shown that the center's physical conditions and equipment affected the patients' satisfaction with health service quality.[27] Li et al.'s study showed that the patients who had to wait for a long time to visit the doctor were more unsatisfied, though good patient–physician communication helped them pay less attention to this problem.[28] Waiting time to visit the physician was one of the predictive factors of the patient's satisfaction.[29],[30] The diverse effect of long waiting times is different in various conditions, though the patients' dissatisfaction may increase when they have to wait too long to visit the physician.[31] This is also true in a primary care unit[32] and clinics,[33] and the waiting time may affect the patient's perception of the efficiency level of the treatment system.[34] Increasing investment and large-scale planning for better development of knowledge is needed by the health system and knowing the necessary components in this field is vital for educational planning.[35]
Limitations
This study had some limitations; considering that the study was conducted in health centers, the findings of this study may not be generalized to hospitals; therefore, the findings of the present study are useful for the health section and the treatment sections need a separate study. Furthermore, the interviews in the present study were conducted in Persian and the people who spoke Turkish or Kurdish, or any language other than Persian were excluded from the study.
| Conclusion | | |
The most important factors affecting patient–physician communication included two main themes of human communication, and health access, which consisted of six subthemes. Increasing awareness and understanding about the factors affecting patient–physician communication and paying attention to these factors can play an important role in the patient's satisfaction and referral for health preventive services. Finally, the identified components can be used to train medical students and also evaluate the communication performance of physicians in health centers. Therefore, the results of this study can provide valuable information for the planners of the health sector to adopt evidence-based policies.
Acknowledgments
The authors of this study appreciate the Heads of health centers, and all participants in the study, and all who assisted us in conducting this thesis (Project Code: IUMS/SHMIS-97-3-37-13177).
Authors' contributions
All authors contributed to this project and article equally. All authors read and approved the final manuscript.
Financial support and sponsorship
The present study was financially supported by Iran University of Medical Sciences.(Project Code: IUMS/SHMIS-97-3-37-13177).
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]
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