“We’ll Do this Together”: The Role of the First Person Plural in Fostering Partnership in Patient-physician Relationships

Kinsman, Helen; Roter, Debra; Berkenblit, Gail; Saha, Somnath; Korthuis, P. Todd; Wilson, Ira B.; Eggly, Susan; Sankar, Andrea; Sharp, Victoria L.; Cohn, Jonathon; Moore, Richard D.; Beach, Mary Catherine

doi:10.1007/s11606-009-1178-3

Cited by 16 publications

(15 citation statements)

References 11 publications

(3 reference statements)

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“…Thus, if physicians in the present study believed, even at an implicit level, that a patient would not be compliant and/or cooperative, they may have seen it necessary to adopt a more authoritative role and exert more control during the medical interaction with that patient. Such an explanation is consistent with Kinsman et al’s finding (2010) that physicians’ statements using first-person plural pronouns are typically authoritative (“ We need to make sure that you take your medicine .”). Alternatively, use of first-person plural pronouns may also simply reflect shared decision-making in medical interactions in some occasions.…”

Section: Discussionsupporting

confidence: 87%

Physician Racial Bias and Word Use during Racially Discordant Medical Interactions

Hagiwara

Slatcher

Eggly

et al. 2016

Health Communication

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114

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Physician racial bias can negatively affect Black patients’ reactions to racially discordant medical interactions, suggesting that racial bias is manifested in physicians’ communication with their Black patients. However, little is known about how physician racial bias actually influences their communication during these interactions. This study investigated how non-Black physicians’ racial bias is related to their word use during medical interactions with Black patients. One hundred and seventeen video-recorded racially discordant medical interactions from a larger study were transcribed and analyzed using Linguistic Inquiry and Word Count (LIWC) software. Physicians with higher levels of implicit racial bias used first-person plural pronouns and anxiety-related words more frequently than physicians with lower levels of implicit bias. There was also a trend for physicians with higher levels of explicit racial bias to use first-person singular pronouns more frequently than physicians with lower levels of explicit bias. These findings suggest that non-Black physicians with higher levels of implicit racial bias may tend to use more words that reflect social dominance (i.e., first-person plural pronouns) and anxiety when interacting with Black patients.

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Section: Discussionsupporting

confidence: 87%

Physician Racial Bias and Word Use during Racially Discordant Medical Interactions

Hagiwara

Slatcher

Eggly

et al. 2016

Health Communication

Self Cite

114

View full text Add to dashboard Cite

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“…We conducted a cross-sectional analysis of data from the Enhancing Communication and HIV Outcomes (ECHO) Study, which was designed to assess possible racial/ethnic disparities in communication in HIV care and to determine which characteristics of interpersonal process are associated with more positive outcomes among patients with HIV [29–33]. Study subjects were HIV clinicians and patients at four HIV care sites in the United States (Baltimore, Detroit, New York, and Portland).…”

Section: Methodsmentioning

confidence: 99%

Clinician empathy is associated with differences in patient–clinician communication behaviors and higher medication self-efficacy in HIV care

Flickinger

Saha

Roter

et al. 2016

Patient Education and Counseling

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Objective We examined associations of clinicians’ empathy with patient-clinician communication behaviors, patients’ rating of care, and medication self-efficacy. Methods We analyzed 435 adult patients and 45 clinicians at four outpatient HIV care sites in the United States. Negative binomial regressions investigated associations between clinician empathy and patient-clinician communication, assessed using the Roter Interaction Analysis System (RIAS). Logistic regressions investigated associations between clinician empathy and patient ratings of clinician communication, overall satisfaction, and medication self-efficacy. Results Clinicians in the highest vs. lowest empathy tertile engaged in less explicitly emotional talk (IRR 0.79, p<0.05), while clinicians in the middle vs. lowest engaged in more positive talk (IRR 1.31, p<0.05), more questions (IRR 1.42, p<0.05), and more patient activating talk (IRR 1.43, p<0.05). Patients of higher empathy clinicians disclosed more psychosocial and biomedical information. Patients of clinicians in both the middle and highest (vs. lowest) empathy tertiles had greater odds of reporting highest medication self-efficacy (OR 1.80, 95% CI 1.16–2.80; OR 2.13, 95% CI 1.37–3.32). Conclusions Clinician empathy may be expressed through addressing patient engagement in care, by fostering cognitive, rather than primarily emotional, processing. Practice Implications Clinicians should consider enhancing their own empathic capacity, which may encourage patients’ self-efficacy in medication adherence.

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“…[12-13, 26-29] Study subjects were HIV care practitioners and patients at four HIV outpatient sites in the United States (Baltimore, Detroit, New York, and Portland). The study received IRB approval from each of the four sites.…”

Section: Methodsmentioning

confidence: 99%

Respecting patients is associated with more patient-centered communication behaviors in clinical encounters

Flickinger

Saha

Roter

et al. 2016

Patient Education and Counseling

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Objective Attitudes towards patients may influence how clinicians interact. We investigated whether clinician-reported respect for patients was associated with communication behaviors during HIV care encounters. Methods We analyzed audio-recordings of visits between 413 adult HIV-infected patients and 45 primary HIV care providers. The independent variable was clinician-reported respect for the patient and outcomes were clinician and patient communication behaviors assessed by the Roter Interaction Analysis System (RIAS). We performed negative binomial regressions for counts outcomes and linear regressions for global outcomes. Results Clinicians with higher respect When clinicians had higher respect for a patient, they engaged in more rapport-building, social chitchat, and positive talk. Patients of clinicians with higher respect for them engaged in more rapport-building, social chitchat, positive talk, and gave more psychosocial information. Encounters between patients and clinicians with higher respect for them had more positive clinician emotional tone [regression coefficient 2.97 (1.92-4.59)], more positive patient emotional tone [2.71 (1.75-4.21)], less clinician verbal dominance [0.81 (0.68-0.96)] and more patient-centeredness [1.28 (1.09-1.51)]. Conclusions Respect is associated with positive and patient-centered communication behaviors during medical encounters by clinicians and patients. Practice Implications Clinicians should be mindful of their respectful attitudes of respect and work to foster positive regard for patients to promote more patient-centered communication and higher quality of care. Educators should consider methods to enhance trainees’ respect in communication skills training.

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“We’ll Do this Together”: The Role of the First Person Plural in Fostering Partnership in Patient-physician Relationships

Cited by 16 publications

References 11 publications

Physician Racial Bias and Word Use during Racially Discordant Medical Interactions

Physician Racial Bias and Word Use during Racially Discordant Medical Interactions

Clinician empathy is associated with differences in patient–clinician communication behaviors and higher medication self-efficacy in HIV care

Respecting patients is associated with more patient-centered communication behaviors in clinical encounters

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