Patient and contextual variables contribute to patients' perception of general practitioners' empathy

Abstract

Objectives: Patient-Perceived Physician Empathy (PPPE) is associated with positive outcomes for patients, quality of care and health expenditure. Research has often focused on physician-related predictors of PPPE, but barriers to empathy in general practice may also be contextual, such as lack of time, or patient-related, such as multimorbidity. Consequently, our aim was to explore the effect of these variables on PPPE.

Methods: In a cross-sectional design, 50 randomly recruited physicians included 20 consecutive adult patients with one or more chronic disease(s). Physician characteristics and work environment data were collected (e.g., gender, age, practice setting, caseload). Physicians filled in patients' diseases, and patients filled in validated self-reported questionnaires on their health, emotional skills (i.e their ability to identify, express and regulate emotions) and their perception of ten physician empathic behaviours (CARE scale). Multilevel linear regressions were performed using SAS.

Results: The median PPPE score was 45 [possible range: 10-50] (n = 762), with higher rates in patients who had seven or more consultations with the physician in the last 12 months and lower in patients with genitourinary and upper gastrointestinal diseases. In consultations ≤ 20 min, the positive effect of longer consultations on PPPE was stronger in patients with low self-reported emotional skills, whereas patients with high self-reported emotional skills gave high ratings on the CARE scale, even in very short consultations of 5-10 min. Among the 11 physician-related candidate variables, only physician age slightly decreased PPPE.

Conclusions: Patient-related and contextual variables were associated with PPPE.

Practice implications: Consultations with infrequently seen patients and patients with low self-reported emotional skills should ideally last at least 20 min to allow the empathic process to unfold. Patients with genitourinary and upper-gastrointestinal diseases should be given special consideration, as they may encounter intimate issues or specific needs requiring more attention.

Keywords: chronic diseases; frequency of consultations; general practice; length of consultation; patient emotional skills; physician empathy.