Tag: doctor–patient interaction

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Patients Still View Doctor’s White Coat as Symbol of Professionalism and Trust

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But women doctors in this attire are often misidentified as nurses or medical assistants. And preferences for doctors’ dress strongly influenced by clinical context/medical specialty

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Patients are still more likely to trust doctors and consider them more professional when they wear white coats, although women doctors in this attire are often misidentified as nurses or medical assistants, finds a review of the available research on the topic, published in the open-access journal BMJ Open.

But patient preferences for doctors’ attire seem to be strongly influenced by clinical context and medical specialty, with a growing acceptance of scrubs, especially in emergency or high-risk settings, the findings indicate.

In the 19th century, doctors primarily wore black, because medical encounters were viewed as serious and formal occasions. But with the growing emphasis on hygiene and scientific advancements in medicine, white coats represented cleanliness and professionalism and became standard attire for doctors worldwide in the 20th century, note the researchers.

Since the publication of a previous comprehensive review of published research on the impact of doctors’ attire at work, which highlighted the significant role this has in patient satisfaction, trust, and adherence to medical advice, health care practices and societal expectations have evolved, they explain.

The researchers therefore wanted to update those findings, broadening the scope to include diverse clinical contexts, in a bid to gain a deeper understanding of how doctors’ attire might influence interactions with patients and treatment outcomes.

They scoured research databases for relevant studies published between January 2015 and August 2024. From an initial haul of 724 studies, 32 were eligible for inclusion in the review.

Most of the studies were carried out in the U.S. (17); two each came from Japan, China, and Pakistan; and the rest were carried out in Indonesia, India, Ethiopia, Korea, Germany, Malaysia, Saudi Arabia, Singapore and Switzerland.

Clinical setting had some bearing on patient preferences. For example, palliative care doctors’ attire didn’t affect patients’ trust, or assessments of the practitioner’s capabilities, but patients preferred emergency care doctors to wear white coats or scrubs. And they were happy for primary care doctors to be dressed casually and to wear white coats.

Specialty also seemed to influence perceptions, with patient preferences for doctors to wear white coats observed in orthopedics, surgery, dermatology, ophthalmology, and obstetrics and gynecology, for example.

The included studies indicated a distinct preference among patients for male doctors to wear suits. One study indicated that accessories, such as watches and glasses worn by male doctors, significantly enhanced perceived professionalism and trustworthiness, which aligns with the findings of previously published studies, note the researchers.

The UK, however, has implemented a ‘bare below the elbows’ policy, which bans doctors from wearing white coats, watches, ties and long sleeves to minimize infection risks.

And even when male and female doctors wore identical attire, female doctors were still more likely to be misidentified as nurses or medical assistants—a misidentification that was consistently observed across different cultural settings.

But patients preferred white coats over business or casual attire for both male and female doctors, and irrespective of gender, they favored doctors wearing white coats, perceiving these practitioners to be trustworthy, respectful, skilled, communicative and empathetic.

Notably, male surgeons wearing a white coat over scrubs were looked on less favorably than those wearing a suit with a white coat, scrubs, or just a suit. On the other hand, female surgeons in white coats over scrubs were preferred over those in suits or casual attire.

“This preference aligns with recent evidence indicating that female physicians are often judged more on appearance than their male counterparts. The way female physicians dress significantly influences perceptions of competence and professionalism, highlighting the gendered expectations that patients hold,” write the researchers.

“These gender-specific preferences for surgical attire were each supported by a single study and warrant further validation… Nonetheless, gender-related perceptions of physician attire were consistently reported across studies with a low risk of bias, supporting the robustness of this theme,” they add.

A few studies explored doctors’ attire during the COVID-19 pandemic, when numerous doctors reported a preference for wearing scrubs to prioritize hygiene and ease of movement.

These studies consistently reported a shift in patient preference towards practical and hygienic attire, such as scrubs and face masks, reflecting heightened sensitivity to infection control, say the researchers.

The researchers acknowledge various limitations to their findings, in particular the fact that most of the included studies were carried out in the U.S., there were none from South America, and only a few from European, Asian, and African countries. Many of the studies also relied on self-reported data, and none included children or patients with mental health issues.

“While the traditional white coat is seen as a symbol of professionalism and trust, patients have increasingly accepted scrubs, especially in emergency or high-risk settings,” they write.

“The expectations regarding attire are often gendered, particularly affecting the recognition and respect given to female physicians, which highlights the importance of institutional initiatives aimed at reducing bias and fostering equitable perceptions among patients,” they add.

Medical institutions should consider adopting flexible dress codes that align with patient preferences for different clinical environments and medical specialties, they suggest.

Source: The BMJ

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Don’t Skip the Numbers When Speaking with Patients

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When a physician says a procedure is “rarely risky,” what does that really mean? Although terms like “common” and “unlikely” may sound descriptive enough, experts in medical decision-making suggest that leaving out numbers may be misleading for patients.

In a paper published in the Journal of General Internal Medicine, a team of researchers and clinicians explained that patients often overestimate risk estimates, like possible side effects or medical conditions, when given only verbal descriptions. They encourage doctors not to shy away from including numbers, offering a list of five science-backed tricks on how to make those numbers count.

“One of the purposes of this paper is to help physicians figure out how to communicate numeric information about risks so that patients can understand and use them to make better choices, take charge of their health and be healthier long term,” said Ellen Peters, a professor at the University of Oregon School of Journalism and Communication and Department of Psychology.

Peters draws on two decades of research on how patients understand numbers and make decisions. She said it’s a common concern that patients won’t understand numerical information, as about a third of American adults have limited numerical skills.

But she’s found that people often prefer getting numbers. According to her previous studies, people rated messages more trustworthy and their messenger more expert when they provided data.

In collaboration with physicians Paul K.J. Han of the National Cancer Institute and Clara N. Lee at the University of North Carolina, Peters hopes their recommended strategies will facilitate stronger shared decision-making between patients and their health care providers.

“There’s a whole raft of strategies that you can use, some of which might be more appropriate in one situation versus the other,” she said. “But by choosing one of them, you can help people use statistics more than they typically would. Otherwise, numbers are just abstract and meaningless.”

  1. Communicate with numbers, not just words

Physicians often default to verbal terms, knowing that a sizable portion of American adults struggle with simple numeric concepts, Peters said. But research has shown that people better understand risks and react appropriately when numbers are discussed alongside verbal descriptions.

“When you present numeric evidence, like the likelihood of side effects for a prescription medication, what ends up happening is that it helps correct people’s original expectation,” Peters said. “They’re much less likely to overestimate the risk and are more likely to take on a physician’s recommendations.”

Do: “Headache is a common side effect and occurs in 7 percent of people.”

Don’t: “Headache is a common side effect.”

  1. Make numbers more manageable

When patients are overwhelmed by medical information, they may rely on mental problem-solving techniques, like gut feelings, pre-existing beliefs and anecdotes they’ve heard from others. To avoid cognitive overload, Peters suggests limiting information to what’s important. If a disease has three intervention options but a patient has a condition that eliminates one as a viable option, she advises not to mention that option.

The authors also suggest clinicians do the math for their patients. For example, they can calculate the risk of birth control based on the number of years the patient expects to use it instead of the annual risk.

Do: Highlight only the key facts and tailor information to the patient’s situation.

Don’t: Provide information that isn’t relevant to a specific patient.

  1. Provide context to statistics

Numbers said alone can be meaningless, so Peters suggests using evaluative labels, like “a 6 percent risk is generally considered poor,” or comparisons to indicate whether it’s high or low risk.

Do: “Ninety-three percent of patients survive with treatment A compared to 99 percent who survive with treatment B.” 

Don’t: “Ninety-three percent of patients survive with treatment A.”

  1. Acknowledge uncertainty

Risk information is an estimate. In some cases, being upfront about the uncertainty of whether a patient will be a part of the 40 percent side or the 60 percent side of a risk, for example, can help convey to patients how seriously they should take it.

Do: “Estimates of the chance of something happening are only a best guess based on the scientific knowledge we have right now. We do not know your personal real risk because of things about you that have never been studied and we don’t yet understand.” 

Don’t: Present numeric risk information as unerringly precise and correct.

  1. Test your communication through the teach-back technique

Experts tend to overestimate how much other people know and how clearly they’ve communicated. So doctors can use the teach-back technique, Peters said, in which they ask their patient to repeat what they understood and found important. The physician can then insert more information to either correct what’s wrong or remind them of something.

Do: “This can be hard to understand. I’d like to make sure I’ve explained it clearly. Could you tell me how you understand the pros and cons of taking drug X?”

Don’t: “What questions do you have?”

Such strategies also can be used by patients to advocate for themselves, Peters said. If told about a possible side effect, they can ask how statistically likely it is. If given too many possible side effects or treatments, they can request to simplify the information to the most important facts.

Peters plans to conduct a series of studies to test which of the five strategies is the most effective. She also is interested in how storytelling and anecdotes affect patient decision-making.

“Physicians have very limited time in any one appointment and are often faced with a similar patient over and over,” Peters said. “What that means is, if you’re trying to help them better communicate with patients, you’ve got to provide things that are fast and scripted so that everyone can make informed decisions about their care.”

Source: University of Oregon

Categories : Mental HealthTags :

Challenges in Caring for Adopted Patients with Limited Family Medical History

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A study based on interviews with primary care physicians has found that treating patients who were adopted is challenging due to limited access to their family medical history. The study, published in Annals of Family Medicine, also found that there was a desire by physicians to fill the information using genetic testing.

Adopted individuals often only have limited information about their biological family, or even none at all, complicating their treatment. The growing availability and popularity of direct-to-consumer genetic testing kits amplifies the need for physicians to be prepared to address genetic testing for adoptees with limited family medical history. To address this, the present study explored the approaches of primary care physicians when caring for adult adopted patients with limited family medical history.

In-depth interviews were conducted by the researchers, including hypothetical clinical scenarios,  with 23 primary care physicians from Rhode Island and Minnesota to understand their experiences, practices, knowledge, and training gaps when addressing limited family medical history and adoption-related issues.

The researchers found that primary care physicians report knowledge gaps and receive little training or resources on adult adoptees with limited family medical history. As a result, they seek guidance around appropriate preventative screening and genetic testing. Limited interaction with adoptees compared to non-adopted patients also influenced perceptions. There was also an over-reliance on stereotypes and the danger of inaccurate media representation affecting how physicians interacted with adoptee patients. Likewise, those physicians who had experience with adoption might be at risk of over-generalising those experiences, especially given how heterogeneous adoptees are as a population.

Furthermore, the researchers found that mental illness and trauma are under-recognised and under-addressed. Care for adoptees includes trauma-informed care which can address factors such as loss, grief, identity development, and to helping adoptees in searching for biological family, reunion, or with complex family dynamics.

To make matters worse, primary care physicians often obtain family medical history imprecisely, risking miscommunication, microaggressions, and damage to the patient-physician relationship.

The findings of this study highlight the significant gaps in knowledge and training for primary care physicians caring for adult adopted patients with limited family medical history. Addressing these gaps may improve the quality of care and strengthen physician-patient relationships. 

Source: EurekAlert!

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Bedside Interdisciplinary Rounds Boost Satisfaction for Both Patients and Providers

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A study led by researchers at the University of Colorado Anschutz Medical Campus reveals that both patients and providers have more positive overall care experiences when the entire healthcare team is a part of bedside interdisciplinary rounds (BIDR).

The findings showed that BIDR, when the team meets at a patients’ bedside in the hospital to discuss care plans, helps build trust between patients and their healthcare providers and within healthcare teams by allowing everyone to observe and work together more closely. The study is out now in the Journal of General Internal Medicine.

“Traditional interdisciplinary rounds (IDR) consist of a clinical care team that coordinates a patient’s care together to help promote collaboration in hospitals. BIDR takes this process a step further by taking the team to the bedside and involving patients and their families,” said lead author Katarzyna Mastalerz, MD, associate professor of hospital medicine at University of Colorado School of Medicine. “BIDR transforms this traditional healthcare model by fostering trust through transparent communication, team collaboration and patient-centred care where every voice is heard, and every goal can be shared.”

 The study interviewed 14 patients and 18 members of a interdisciplinary teams that included nurses, pharmacists and care coordinators.

Patients who participated in BIDR expressed positive feelings about being involved in their healthcare plans, which enhanced their trust in providers. Healthcare professionals reported improved respect and trust among colleagues, which contributed to better patient care.

While results were mostly promising, patients and providers said there is room for improvement to make the process more streamlined.

For example, some patients reported being uncomfortable due to the use of technical jargon and unclear communication regarding their treatment plans. Meanwhile, the providers said they faced challenges related to lack of supportive structures for interprofessional collaboration and lengthy presentations by physicians.

“To build effective BIDR, we suggest healthcare teams use transparency by sharing goals with patients, employing accessible patient-centred language, clearly delineating team roles for each team member, and actively addressing team input in real time” said Mastalerz. “With the professional siloes and hectic workflow that often characterise hospitals, it’s especially important for hospital leadership to recognise, support, and create opportunities for collaborative work by interprofessional teams.”

Source: University of Colorado Anschutz Medical Campus

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Does Giving Lifestyle Advice Really Work?

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Healthcare professionals are increasingly giving advice to patients on how to improve their health, but there is often a lack of scientific evidence if this advice is actually beneficial. This is according to a study from the University of Gothenburg, which also guides towards more effective recommendations.

The researchers do not criticise the content of the advice – after all, it is good if people lose weight, stop smoking, eat a better diet or exercise more. But there is no evidence that patients actually do change their lifestyle after receiving this advice from healthcare professionals.

“There is often a lack of research showing that counselling patients is effective. It is likely that the advice rarely actually helps people,” says study lead author Minna Johansson, Associate Professor at Sahlgrenska Academy at the University of Gothenburg and General Practitioner at Herrestad’s Healthcare Center in Uddevalla.

Few pieces of advice are well-founded

The study, published in the Annals of Internal Medicine, was conducted by an international team of researchers. They have previously analysed medical recommendations from the National Institute for Health and Care Excellence (NICE) in the UK. This organisation is behind 379 recommendations of advice and interventions that healthcare professionals should give to patients, with the aim of changing their lifestyle.
 
In only 3% of cases there were scientific studies showing that the advice has positive effects in practice. A further 13% of this advice had some evidence, but with low certainty. The researchers also reviewed additional guidelines from other influential institutions around the world and found that these often overestimate the positive impact of the advice and rarely take disadvantages into account.
 
“Trying to improve public health by giving lifestyle advice to one person at a time is both expensive and ineffective. Resources would probably be better spent on community-based interventions that make it easier for all of us to live healthy lives,” says Minna Johansson, who also believes the advice could increase stigmatisation for people with, eg, obesity.

Showing the way forward

Today’s healthcare professionals would not be able to give all the advice recommended while maintaining other care. The researchers’ calculations show that in the UK, for example, five times as many nurses would need to be hired, compared to current levels, to cope with the task.
 
The study also presents a new guideline to help policy makers and guideline authors consider the pros and cons of the intervention in a structured way before deciding whether or not to recommend it.
 
Victor Montori, Professor of Medicine at the Mayo Clinic in the United States is a co-author of the study:
“The guideline consists of a number of key questions, which show how to adequately evaluate the likelihood that the lifestyle intervention will lead to positive effects or not,” says Victor Montori.

Source: University of Gothenburg

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Meeting at Eye Level in Hospitals Improves Patient Experience and Outcomes

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Review of research suggests patients feel better when providers sit or crouch during bedside conversations

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Doctors and other healthcare workers, you may want to sit down for this news. A systematic review of studies suggests that getting at a patient’s eye level when talking with them about their diagnosis or care can really make a difference. 

Their findings, published in the Journal of General Internal Medicine, revealed that sitting or crouching at a hospitalised patient’s bedside was associated with more trust, satisfaction and even better clinical outcomes than standing, according to the review of evidence.

The study’s authors, from the University of Michigan and VA Ann Arbor Healthcare System, note that most of the studies on this topic varied with their interventions and outcomes, and were found to have high risk of bias. 

So, the researchers sat down and figured out how to study the issue as part of their own larger evaluation of how different nonverbal factors impact care, perceptions and outcomes.

Until their study ends, they say their systematic review should prompt clinicians and hospital administrators to encourage more sitting at the bedside. 

Something as simple as making folding chairs and stools available in or near patient rooms could help – and in fact, the VA Ann Arbor has installed folding chairs in many hospital rooms at the Lieutenant Colonel Charles S. Kettles VA Medical Center.

Nathan Houchens, MD, the U-M Medical School faculty member and VA hospitalist who worked with U-M medical students to review the evidence on this topic, says they focused on physician posture because of the power dynamics and hierarchy of hospital-based care. 

We hope our work will bring more recognition to the significance of sitting and the general conclusion that patients appreciate it.”

-Nathan Houchens, M.D.

An attending or resident physician can shift that relationship with a patient by getting down to eye level instead of standing over them, he notes. 

He credits the idea for the study to two former medical students, who have now graduated and gone on to further medical training elsewhere: Rita Palanjian, M.D., and Mariam Nasrallah, M.D. 

“It turns out that only 14 studies met criteria for evaluation in our systematic review of the impacts of moving to eye level, and only two of them were rigorous experiments,” said Houchens. 

“Also, the studies measured many different things, from length of the patient encounter and patient impressions of empathy and compassion, to hospitals’ overall patient evaluation scores as measured by standardised surveys like the federal HCAHPS survey.”

In general, he says, the data paint the picture that patients prefer clinicians who are sitting or at eye level, although this wasn’t universally true. 

And many studies acknowledged that even when physicians were assigned to sit with their patients, they didn’t always do so – especially if dedicated seating was not available. 

Houchens knows from supervising U-M medical students and residents at the VA that clinicians may be worried that sitting down will prolong the interaction when they have other patients and duties to get to. 

But the evidence the team reviewed suggests this is not the case. 

He notes that other factors, such as concerns about infection transmission, can also make it harder to consistently get to eye level. 

“We hope our work will bring more recognition to the significance of sitting and the general conclusion that patients appreciate it,” said Houchens. 

Making seating available, encouraging physicians to get at eye level, and senior physicians making a point to sit as role models for their students and residents, could help too. 

A recently launched VA/U-M study, funded by the Agency for Healthcare Research and Quality and called the M-Wellness Laboratory study, includes physician posture as part of a bundle of interventions aimed at making hospital environments more conducive to healing and forming bonds between patient and provider. 

In addition to encouraging providers to sit by their patients’ bedsides, the intervention also includes encouraging warm greetings as providers enter patient rooms and posing questions to patients about their priorities and backgrounds during conversations.

The researchers will look for any differences in hospital length of stay, readmissions, patient satisfaction scores, and other measures between the units where the bundle of interventions is being rolled out, and those where it is not yet.

Source: University of Michigan

Categories : Obstetrics & GynaecologyTags :

Choice of Words Matters for PCOS Patients’ Wellbeing

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The choice of words that doctors doctors use when diagnosing female patients with polycystic ovary syndrome (PCOS) can negatively impact their wellbeing and how they view their condition later on in life, according to new research published in the British Journal of General Practice.  

PCOS can result in a range of physical symptoms, such as dysmenorrhoea or amenorrhoea, and metabolic issues. University of Surrey researchers found that the use of the word ‘raised’ by practitioners when discussing test results can lead to higher levels of body dissatisfaction and dieting behaviour amongst women, whilst the use of the word ‘irregular’ can result in concerns about fertility. 

Jane Ogden, Professor of Health Psychology at the University of Surrey, said: “Diagnostic consultations may take a few minutes, yet how these minutes are managed, what words are used and how this makes a patient feel may change how they make sense of their condition and influence their wellbeing in the longer term. It is important that doctors have an awareness of the words they use and think about how they could be perceived by patients.”  

In one of the first studies of its kind, researchers investigated the impact of PCOS diagnostic consultations and whether the language used impacted the subsequent wellbeing of patients.

To assess the impact, researchers surveyed 147 females with PCOS and asked about their satisfaction with their consultation, the language used during it and their overall wellbeing.  

Researchers found that those who had felt uncomfortable with the consultation process were more likely to report poorer body esteem, reduced quality of life and greater concerns about health in later life. Over a quarter of those surveyed were dissatisfied with how doctors managed their distress and were unhappy with the lack of rapport they had with their practitioners.  

Prof Ogden added: “Words matter, as patients often replay conversations that they have had with doctors in a bid to make sense of situations. Although words such as ‘raised’ and ‘irregular’ are simple words they are vague which can cause women to worry, as they automatically think the worst, as they have not been provided with all the facts. Such anxiety at the time of diagnosis, can negatively impact how they feel about themselves as their life progresses.” 

Source: University of Surrey