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3A: Evidence suggests that patient satisfaction is associated more with physicians style of
practice than with the technical quality of their care (lecture; Chang; Bertakis). More
specifically, patients subjective experiences of care are positively associated with the
interpersonal quality of interactions with physicians, including physician-patient communication
(e.g., listening carefully to patients, explaining things in understandable ways, etc.); a physician
psychosocial style that emphasizes patient activation and counseling (i.e., discussing what the
patient knows/believes about health and disease, physician discussion of interpersonal relations,
etc.); and a physician style that is authoritative, rather than authoritarian (lecture; Chang;
Bertakis; Frosch). To that end, I would advise a company providing primary health care through
a network of outpatient clinics to encourage its physicians to communicate with patients openly,
encourage patients to ask questions, take the time to counsel patients, and even chit-chat or make
small talk so as to improve patients perception of their experience. In other words, as Bertakis
et al. (1998) describe, advise physicians to practice as though they were trained in the philosophy
of family practice, regardless of their actual specialty.
3B: Given how physician practice style affects patient assessments of care (as described in 3A), I
would recommend that organizations staff primary care practices so that physician characteristics
align with patient characteristics with the goal of improving the interpersonal quality of
physician-patient interactions. Cooper et al. demonstrated that concordant patient-physician
relationships resulted in longer encounters with more patient-centered communication, resulting
in higher patient satisfaction (lecture; Cooper). Jerant et al., however, did not find strong
associations between physician-patient gender and/or race concordance and communication
(lecture; Jerant). However, evidence suggests that female physicians are more likely to engage
patients in longer encounters and spend more time on preventive care, which is associated with
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better patient assessments (lecture; Hall). Overall, the evidence on physician-patient concordance
(with respect to race and gender) is a mixed bag (lecture). I would recommend, though, that
primary care practices attempt to align physician characteristics with the characteristics of patient
populations in light of the small positive effects that research demonstrates to date.
3C: Given the evidence on why people seek and use complementary and alternative medicine
(CAM), I would not necessarily recommend that primary care practices increase the availability
of CAM services in order to improve patient assessments of care. The substantial increase in the
use of CAM since the 1990s is, in large part, related to the rise in the cost of conventional health
care and is associated with lack of access to conventional health care (Pagan, lecture). Thus,
patients who are able to obtain conventional health care in primary care settings are, presumably,
able to afford conventional care and perhaps less likely to resort to using CAM. In other words, it
appears that CAM may be a substitute for conventional medical care when such care is out of
reach for patients, and not simply a preferred approach to health because it is more in line with
patients health-related beliefs and values (Pagan). However, Eisenberg et al. show that
individuals appear to use CAM in addition to conventional medical care and that the majority of
CAM users do not discuss CAM with their regular doctor (lecture). In this case, CAM appears to
be a complement to conventional medical care. In both cases, offering CAM in primary care
settings will not necessarily improve patient assessments of care; however, it may be more likely
to improve patient assessments of care in the latter case compared to the former case (i.e., if
CAM is a complement to, rather than a substitute for conventional medical care). I then would
advise that physicians determine on a patient-by-patient basis whether discussing CAM is likely
to improve the interpersonal quality of the physician-patient interaction.