Results suggest that the objective severity of patients' disease conditions, and their awareness of this severity, can predict their adherence. Patients who are most severely ill with serious diseases may be at greatest risk for nonadherence to treatment. Findings can contribute to greater provider awareness of the potential for patient nonadherence, and to better targeting of health messages and treatment advice by providers.

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Objective: To assess the effects of a communication skills training program for physicians and patients. Design: A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). Main Outcome Measures: Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians' satisfaction and stress; and global ratings of the communication process. Results:The following significant ( p Ͻ .05) effects emerged: physician training improved patients' satisfaction with information and overall care; increased willingness to recommend the physician; increased physicians' counseling (as reported by patients) about weight loss, exercise, and quitting smoking and alcohol; increased physician satisfaction with physical exam detail; increased independent ratings of physicians' sensitive, connected communication with their patients, and decreased physician satisfaction with interpersonal aspects of professional life. Patient training improved physicians' satisfaction with data collection; if only physician or patient was trained, physician stress increased and physician satisfaction decreased. Conclusion: Implications for improving physician-patient relationship outcomes through communication skills training are discussed.

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Background Depression and anxiety are common disorders, however their occurrence during pregnancy has the potential to significantly impact the health and wellbeing of both mother and child [1, 2]. Negative outcomes of mental health disorders in pregnancy include a variety of serious complications. Inadequately treated depression is associated with a substantial risk of maternal, fetal and neonatal morbidity and mortality [3]. In addition to subjective distress, the impact on relationships can be very significant, particularly when attachment to the newborn is disrupted. This may lead to enduring detrimental effects on the child extending into adulthood [4]. Depression also leads to suicide, with it being the second largest cause of indirect maternal mortality in the perinatal period in Australian women [1]. Unclear messages contribute to pregnant women being reluctant to take psychotropic medication, including antidepressants and anxiolytics with many fearing foetal harm [5-8]. Medical personnel including O&Gs and GPs form an important part of a pregnant woman's network of information sources during pregnancy and can impact patient decision-making around medications in pregnancy [7-9]. The Australian clinicians' own

Background: The decision of whether to prescribe antidepressants (AD) and anxiolytics (AX) to pregnant women is complex, with serious potential ramifications. Clinicians’ perception of the risk of teratogenicity significantly influences their prescribing decisions and in turn impacts maternal decision making. Our cross-sectional study sought to discern differences in perceived risk between Obstetricians and Gynaecologists (O&Gs) and General Practitioners (GPs) when prescribing these medications in pregnancy. Furthermore, we investigated factors impacting perception, clinicians’ willingness to prescribe and their approach to provision of patient information. Methods: This cross-sectional study was conducted via a nation-wide online SurveyMonkey extended to Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) database-derived affiliates: GP diplomates, fellows and trainees (5409 survey invitations: 545 respondents). O&Gs and GPs were compared using Pearson Chi-squared test for categorical variables and the Student t-test for continuous variables. Results: GPs reported higher rates of being aware of up-to-date medication prescription recommendations (57.6%) compared with O&Gs (44.2%). GPs also reported higher rates of training adequacy in psychotropic prescription (56.1% versus 29.0%). There was evidence to suggest GPs level of confidence in knowledge base, initiation and prescription of AD and AX was higher than those of O&Gs. The mean perception of patient non-compliance was similar between clinician groups (approximately 35%), but GPs perceived the extent of patient anxiety as higher compared to O&Gs (mean 73.7% (SD 21.3) versus 63.1% (SD 24.1), p<0.001). Both groups showed a strong preference for improved training rather than patient-focused technology (above 70% for both groups). Conclusion: Further development of clinician training in perinatal psychotropic prescription is warranted.

This study investigates the role of gender in physician-patient communication among African American patients in primary care. Patients (N = 137) aged 33 to 67 were nested within 79 southern California primary care physicians' practices. In 48 interactions (35%), the physician was female and/or a member of a minority group. The study directly assessed gender differences through audiotaped physician-patient interactions as well as by measuring patients' and physicians' perceptions of their visit. This study employed a multi-informant design, in which independent raters assessed both physician and patient in audiotaped interactions, and both physician and patient self-reported on aspects of their visit. Discussions of prevention and health promotion were found to be significantly more common with male patients than with female patients but only when the physician was a nonminority male; these disparities disappeared when the physician was female and/or minority. Findings are discussed in terms of physician training, particularly for men and nonminorities.