General Practitioners’ Empathy and Health Outcomes: A Prospective Observational Study of Consultations in Areas of High and Low Deprivation

Abstract

PURPOSE We set out to compare patients' expectations, consultation characteristics, and outcomes in areas of high and low socioeconomic deprivation, and to examine whether the same factors predict better outcomes in both settings.METHODS Six hundred fifty-nine patients attending 47 general practitioners in high-and low-deprivation areas of Scotland participated. We assessed patients' expectations of involvement in decision making immediately before the consultation and patients' perceptions of their general practitioners' empathy immediately after. Consultations were video recorded and analyzed for verbal and nonverbal physician behaviors. Symptom severity and related well-being were measured at baseline and 1 month post-consultation. Consultation factors predicting better outcomes at 1 month were identified using backward selection methods. RESULTSPatients in deprived areas had less desire for shared decision-making (P <.001). They had more problems to discuss (P = .01) within the same consultation time. Patients in deprived areas perceived their general practitioners (GPs) as less empathic (P = .02), and the physicians displayed verbal and nonverbal behaviors that were less patient centered. Outcomes were worse at 1 month in deprived than in affluent groups (70% response rate; P <.001). Perceived physician empathy predicted better outcomes in both groups.CONCLUSIONS Patients' expectations, GPs' behaviors within the consultation, and health outcomes differ substantially between high-and low-deprivation areas. In both settings, patients' perceptions of the physicians' empathy predict health outcomes. These findings are discussed in the context of inequalities and the "inverse care law."

Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations

“…15 The study comprised patient-administered questionnaires and videotaping of consultations. The study protocol and recruitment procedures have been previously reported.…”

“…The study protocol and recruitment procedures have been previously reported. 15 Ethical approval of the study was obtained from the local research ethics committee (approval number: REC/06/SO701/43) and informed consent was obtained from all participating GPs and patients.…”

“…15 In brief, 20 practices, 47 GPs, and 659 patients (339 with multimorbidity) participated (13 practices, 25 GPs, 356 patients in high-deprivation areas including 207 patients with multimorbidity; 7 practices, 22 GPs, 303 patients in low-deprivation areas with 132 patients with multimorbidity). Practices were recruited from the upper and lower quartile of deprivation (Scottish Index of Multiple Deprivation, SIMD 2006) 16 in the Greater Glasgow and Clyde health board area, Scotland, United Kingdom.…”

“…15 Immediately after consultation, patients reported their perceptions of the GP's empathy using the Consultation and Relational Empathy (CARE) 17 measure.…”

“…12 Empathic, patient-centered care is a prerequisite for patient enablement and improves health outcomes in both affluent and deprived areas. [13][14][15] In the present study, we examined the influence of multimorbidity on general practice consultations, in areas of high and low socioeconomic deprivation. We hypothesized that in affluent areas, where workforce pressures are less severe, 11 the greater needs and complexity of patients with multimorbidity would result in longer consultations, and more empathic, patientcentered care than in less complex patients without multimorbidity, but that in deprived areas, due to the ongoing inverse care law, 11 these effects of multimorbidity on the consultation would not be possible.…”