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Patient Perceptions of Osteopathic and Allopathic Physician Communication Style and Empathy and Reported Satisfaction with Low Back Care
Licciardone, J. C. [75]
Schmitt, M. E. [2]

Journal: Journal of Osteopathic Medicine Date: 2018/11, 118(11):Pages: e190-e192. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

communication [72]
cross sectional study [597]
empathy [50]
osteopathic physicians [163]
patients [80]
perception [89]
physician-patient relations [83]
satisfaction [52]
USA [1086]

Abstract:

Significance: The osteopathic tradition promotes physician behaviors and attributes believed to improve health outcomes for patients. Physician attributes such as open communication, patient involvement, and empathy are reflective of key aspects of the interactions between physicians and patients in the contemporary health care environment. Researchers in the osteopathic field often seek to measure these attributes, test their association with the osteopathic practice of medicine, and measure the relationships between these ideal physician attributes and patient outcomes. Hypothesis: We hypothesize that patients of osteopathic physicians will report more favorable perceptions of physician communication and empathy, as well as greater satisfaction with medical care, than patients of allopathic physicians. Methods: The patients in this study were recruited from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) at the University of North Texas Health Science Center from April 2016 through June 2018. Eligible patients were adults with subacute or chronic low back pain who reported having either an osteopathic or allopathic physician as the main provider for their back care. At baseline, each patient completed a series of validated research instruments relating to their low back pain and the physician who provided medical care for it. The Physician Communication Behavior Questionnaire was used to measure: patient participation and patient orientation; effective and open communication; emotionally supportive communication; and communication about personal circumstances. Physician empathy was measured primarily with the Consultation and Relational Empathy Measure and secondarily with the Jefferson Scale of Patient's Perceptions of Physician Empathy. Patient satisfaction was measured using the 8 dimensions within the Patient Satisfaction Questionnaire with 18 items, and with the Scale of Patient Overall Satisfaction with Primary Care Physicians. Differences between osteopathic and allopathic physicians on each measure were assessed using the t test. The sample size was sufficient to detect at least “medium” differences between physician groups (Cohen's d≥ 0.50) with α≤.05 and β≥0.99. The study was approved by the North Texas Regional Institutional Review Board. Results: A total of 308 patients were eligible for the study, including 208 women (67.5%) and 270 patients (87.7%) with chronic low back pain. The mean (SD) age of patients was 54.3 (11.3) years. A total of 96 patients (31.2%) reported having an osteopathic physician as their main provider for back care. Although patients of osteopathic physicians generally reported more favorable perceptions of physician communication and empathy and greater satisfaction with back care than did patients of allopathic physicians, none of the results achieved statistical significance (Table). A post-hoc analysis of these results found that physician group differences for consultation and relational empathy (Cohen's d=0.20) and general satisfaction (Cohen's d=0.20) would be classified as “small,” with the physician group differences on the remaining 12 measures classified as “trivial” (Cohen's d<0.20). Discussion: Our findings indicate that differences between osteopathic and allopathic physicians in their communication styles and empathy were not likely to be clinically relevant. Correspondingly, differences in patient satisfaction between the physician groups were also small or trivial. Although previous research has shown that there appears to be a distinctive osteopathic approach to treating patients with low back pain, the present findings suggest that factors other than the patient-physician interaction are more important in defining the “osteopathic difference.” Less reliance on pharmacotherapy, use of osteopathic manipulative treatment, and continuity of care may be more reflective of the osteopathic difference in treating patients with low back pain. The strengths of our study include a pragmatic design using patient-reported data within a community-based research registry and adequate statistical power. A potential limitation is that patient-physician interactions were not video- or audio-recorded to corroborate the reported findings or to discern more subtle differences between the physician groups not captured by patient self-report instruments. The next step in our research will be to identify other factors that may represent mediators or moderators in explaining the relationship between osteopathic treatment of low back pain and patient outcomes relating to pain intensity, back-related functioning, and health-related quality of life. Conclusion: The overall findings of this study indicate that differences between osteopathic and allopathic physicians with respect to communication style and empathy were not likely to be clinically relevant in treating patients with subacute or chronic low back pain, and that differences in patient satisfaction between the physician groups were correspondingly small or trivial.

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