Patient Safety and Quality

Studies examine patients' ratings of physicians

In the future, patient ratings of physicians may be used for recredentialling by physician specialty boards and determining physician bonus payments. Several patient and physician factors, including physician personality, influence patients' ratings of physicians, according to a new study. A second study calls into question the use of subjective patient ratings to evaluate physician performance. Both studies were supported by the Agency for Healthcare Research and Quality (HS10610) and are discussed here.

Duberstein, P., Meldrum, S., Fiscella, K., and others (2007, February). "Influences on patients' ratings of physicians: Physicians demographics and personality." Patient Education and Counseling 65, pp. 270-274.

This study identified several patient and physician factors that influenced patients' ratings of physicians. Physician gender was the only significant determinant of patient ratings of physicians who had treated them for a short time. For example, patients treated by a physician for 1 year or less rated male physicians higher than female physicians. This gender difference disappeared after 1 year.

Two physician personality traits, openness and conscientiousness, were associated with patients' ratings in lengthier patient-physician relationships. Patients tended to be more satisfied with doctors who were relatively high in openness and average in conscientiousness. Patient characteristics also influenced physician ratings. Older patients and those with a greater medical burden rated their physicians higher than younger and less burdened patients.

A learning environment could be created to reinforce certain physician personality traits and corresponding habits that enhance patient satisfaction. Such a shift in the culture of medical education and practice could have important implications for patient care, note the researchers.

Their findings were based on analysis of 4,616 patients and their physicians at New York primary care practices. They stratified the length of the patient-physician relationship and used factor analysis of data from several questionnaires and surveys to determine factors that influenced patients' satisfaction with physicians.

Fiscella, K., Franks, P., Srinivasan, M., and others (2007, March). "Ratings of physician communication by real and standardized patients." Annals of Family Medicine 5(2), pp. 151-158.

This study calls into question the use of subjective patient ratings to evaluate physician performance. The researchers compared ratings of 96 community physicians by 49 real patients and 2 standardized patients who portrayed symptoms of gastroesophageal disorder reflux and poorly characterized chest pain with multiple unexplained symptoms.

Standardized patients, persons trained to portray a specific patient case in a standardized fashion, represent a potentially more objective means to assess physician communication, since they are not influenced by longevity of relationship and other personal factors. In this study, real patient and standardized patient ratings of physician communication style differed substantially. The real and standardized patients completed a modified version of the Health Care Climate Questionnaire (HCCQ) for each physician, which measures physician support of patient autonomy, a key dimension in patient-centered communication.

Compared with standardized patient scores, real patient HCCQ scores were higher (mean 22.0 vs. 17.2), standard deviations were lower (3.1 vs. 4.9), and ranges were similar (both 5 to 25). The standardized patient ratings of physician communication skills showed superior psychometric properties. A single postvisit standardized patient rating was far more reliable than a single real patient self-report either before or after a clinic visit.

Also, real and standardized patient ratings yielded quite different rankings of physicians for autonomy support. The low correlation in physician ranking based on real and standardized patient ratings suggests caution in using only real patient ratings for physician pay-for-performance or recredentialing. Different physicians would be rewarded for their interpersonal skills, depending on which measurement approach was used.

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