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Comparative Study
. 2008 Oct;23(10):1581-8.
doi: 10.1007/s11606-008-0702-1. Epub 2008 Jul 10.

Physician burnout and patient-physician communication during primary care encounters

Neda Ratanawongsa  1 , Debra Roter, Mary Catherine Beach, Shivonne L Laird, Susan M Larson, Kathryn A Carson, Lisa A Cooper
Affiliations
Comparative Study

Physician burnout and patient-physician communication during primary care encounters

Neda Ratanawongsa et al. J Gen Intern Med. 2008 Oct.

Abstract

Background: Although previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies relate physician burnout to observed patient-physician communication behaviors.

Objective: To investigate the relationship between physician burnout and observed patient-physician communication outcomes in patient-physician encounters.

Design: Longitudinal study of enrollment data from a trial of interventions to improve patient adherence to hypertension treatment.

Setting: Fifteen urban community-based clinics in Baltimore, MD.

Participants: Forty physicians and 235 of their adult hypertensive patients, with oversampling of ethnic minorities and poor persons. Fifty-three percent of physicians were women, and the average practice experience was 11.2 years. Among the 235 patients, 66% were women, 60% were African-American, and 90% were insured.

Measurements: Audiotape analysis of communication during outpatient encounters (one per patient) using the Roter Interaction Analysis System and patients' ratings of satisfaction with and trust and confidence in the physician.

Results: The median time between the physician burnout assessment and the patient encounter was 15.1 months (range 5.6-30). Multivariate analyses revealed no significant differences in physician communication based on physician burnout. However, compared with patients of low-burnout physicians, patients of high-burnout physicians gave twice as many negative rapport-building statements (incident risk ratio 2.06, 95% CI 1.58-2.86, p < 0.001). Physician burnout was not significantly associated with physician or patient affect, patient-centeredness, verbal dominance, or length of the encounter. Physician burnout was also not significantly associated with patients' ratings of their satisfaction, confidence, or trust.

Conclusions: Physician burnout was not associated with physician communication behaviors nor with most measures of patient-centered communication. However, patients engaged in more rapport-building behaviors. These findings suggest a complex relationship between physician burnout and patient-physician communication, which should be investigated and linked to patient outcomes in future research.

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Figures

Figure 1
Figure 1
Conceptual model of the relationship between physician burnout and patient-physician communication. *Variables included in final multivariate model. US vs. international medical school status was included as an effect modification variable.
See this image and copyright information in PMC

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