Perceptions of Physician and Inpatient Communication

Communication between patients and physicians is central to establishing good clinical relationships. It also improves adherence to medication therapies and patient satisfaction with the care he or she receives. Care that focuses on the patient contributes to collaboration among physicians, patients, and families, and helps ensure a safe transition upon hospital discharge. Hospital surveys have shown that many patients do not know their physicians’ names, cannot identify their diagnoses, and are not aware of all aspects of management of their medications; at the same time, however, physicians report they effectively communicate with their patients. Researchers recently conducted a study to assess patient knowledge and perspectives of inpatient care and compare those perceptions with physicians’ assessments. Study results were reported in Archives of Internal Medicine [2010;170(15):1302-1307]. The cross-sectional study was conducted at Waterbury Hospital, a 367-bed, private, not-forprofit community teaching hospital in Connecticut. Patients treated by house staff from October 10, 2008, through June 23, 2009, were asked to participate. The house staff teams included 1 attending physician, 1 resident, 1 primary intern, and a secondary intern who provided patient care on postcall and select weekend days. The patients’ experiences were evaluated using 2 validated Likert-style questionnaires: the Picker Patient Experience Questionnaire and the Consumer Assessment of Healthcare Providers and Systems Hospital Survey. The researchers also surveyed the corresponding internal medicine resident and attending physicians, asking them to report on their care of the inpatients and their understanding of their patients’ perceptions of the care received. The researchers did not share patient responses with the physicians or physician responses with the patients. There were 95 patients eligible to participate in the survey; of those, 94% (n=89) agreed to complete the questionnaires. Of the 43 physicians asked to participate, 100% did so. According to the patients’ responses, they had an average of 5.1 physicians caring for them throughout their hospital stay; mean length of stay was 5.4 days. Seventy-three percent of patients (n=65) thought there was 1 main physician providing care to them; of those, 18% (n=16) could correctly name the physician, compared with 67% (n=28) of physicians who thought patients knew their names (P<.001). Compared with 77% (n=69) of physicians who thought their patients understood their diagnosis at least somewhat well, only 57% (n=51) of patients could correctly state their diagnosis. Thirty-eight patients either did not know their diagnosis or incorrectly stated the reason for their admission to the hospital (P<.001). Fifty-eight percent of patients (n=52) thought their physician always explained things comprehensibly, but only 21% (n=9) of physicians said they always provided explanations of some kind (P<.001). Of the 50% of patients who said they had anxiety or fear while in the hospital, 54% (n=25) said their physicians never discussed the fears with them, compared with 98% of physicians who said they at least sometimes discussed patients’ anxiety or fears with them (P=.001). Of the 67% of patients (n=60) who said they had received a new medication in the hospital, 25% (n=15) said their physicians did not tell them they were receiving a new medication, compared with 100% (n=98) of physicians who said they at least sometimes inform patients about new medications (P=.04). Ninety percent of the patients who received a new medication while in the hospital reported never being told of adverse effects; 19% of physicians stated they never discuss adverse effects of medications with patients (P<.001). The researchers summarized by noting that “significant differences exist between patients’ and physicians’ impressions about patient knowledge and inpatient care received. Steps to improve patient–physician communication should be identified and implemented,” they concluded.