Research ArticleOriginal Research

Physician Empathy and Listening: Associations with Patient Satisfaction and Autonomy

Kathryn I. Pollak, Stewart C. Alexander, James A. Tulsky, Pauline Lyna, Cynthia J. Coffman, Rowena J. Dolor, Pål Gulbrandsen and Truls Østbye
The Journal of the American Board of Family Medicine November 2011, 24 (6) 665-672; DOI: https://doi.org/10.3122/jabfm.2011.06.110025

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Recruitment/participant flow. *Because there were many appointments from which to select, we assigned each appointment a random number and randomly selected which appointments to attempt to audio record.

  • Figure 2.
    Figure 2.

    Proportion of motivational interviewing (MI) techniques during physician encounters.

Tables

  • Table 1.

    Patient and Visit Characteristics for Patients in Weight-Related Discussions* (n = 320)

    Patient characteristics
        Baseline weight, kg (mean [SD])93.9 (21.2)
        Obese (BMI ≥30)61 (194)
        Race
            White/Asian61 (196)
            African American39 (124)
        Male34 (108)
        Age, years (mean [SD])58.4 (13.3)
        >High school education (missing 1)†68 (217)
        Economic security: can pay bills easily (missing 11)88 (272)
        Medical history
            Diabetes33 (104)
            Hypertension68 (217)
            Hyperlipidemia (missing 1)56 (180)
            Arthritis43 (136)
        Weight loss
            Very motivated to lose weight versus somewhat to not at all‡58 (184)
            Very confident can lose weight versus somewhat to not at all confident§36 (115)
            Very comfortable discussing weight with physician versus somewhat to not at all∥73 (234)
            Tried to lose weight during past month49 (158)
    Visit factors (n = 320)
        Total patient-medical personnel in-room time, min (mean [SD])25.9 (10.2)
        Total time spent discussing weight, min (mean [SD])4.2 (3.4)
        Who initiated the weight discussion?
            Physician36 (115)
            Patient64 (205)
            Weight not discussed0 (0)
        Type of encounter (missing 2)
            Preventive39 (123)
            Chronic care61 (195)
        Explicit weight discussion76 (242)

    • Values provided as % (n) unless otherwise indicated.

    • ↵* Patients were considered “counseled” when physicians used motivational interviewing techniques when discussing weight.

    • ↵† Missing data at baseline (counseled sample).

    • ↵‡ Motivation to lose weight/address weight (1 = not at all, 7 = very much).

    • ↵§ Self-efficacy to lose weight/address weight (1 = not at all confident, 5 = very confident).

    • ↵∥ Comfort discussing weight (1 = not at all comfortable, 5 = very comfortable).

    • BMI, body mass index.

  • Table 2.

    Patient Characteristics and Satisfaction and Autonomy Support

    Patient CharacteristicsTotal (n)Excellent SatisfactionHigh Perceived Autonomy Support
    Weight
        Obese (BMI ≥30)19411 (22)36 (69)
        Not obese (BMI <30)12613 (16)42 (53)
    Race
        White/Asian19612 (23)38 (74)
        African American12412 (15)39 (48)
    Sex
        Male1088 (9)32 (35)
        Female21214 (29)41 (87)
    Age, years* (mean [SD])32055.4 (13.1)59.6 (13.2)
    Education (missing 1)
         >High School21713 (29)35 (76)
        ≤High School1029 (9)45 (46)
    Economic security (missing 11)
        Cannot pay bills easily3714 (5)38 (14)
        Can pay bills easily27212 (32)38 (103)
    Medical history
        Diabetes10410 (10)34 (35)
        Hypertension21711 (24)40 (86)
        Hyperlipidemia (missing 1)18013 (24)41 (73)
        Arthritis13611 (15)43 (59)
    Motivated to lose weight
        Very motivated18415 (27)42 (77)
        Somewhat to not at all1368 (11)33 (45)
    Confident can lose weight
        Very confident11517 (19)50 (57)
        Somewhat to not at all2059 (19)32 (65)
    Comfortable discussing weight with physician
        Very comfortable23415 (35)44 (104)
        Somewhat to not at all864 (3)21 (18)
    Tried to lose weight in past month
        Yes15811 (17)42 (66)
        No16213 (21)35 (56)

    • Values provided as % (n) unless otherwise indicated.

    • * Mean (SD) for excellent satisfaction and very high perceived autonomy support.

    • BMI, body mass index.

  • Table 3.

    Physician Communication and Satisfaction and Perceived Autonomy Support

    ModelTotal (n)Excellent satisfaction* (% [95% CI])Total (n)High perceived autonomy support† (% [95% CI])
    MI spirit
        >1379 (3–23)3628 (15–46)
        128312 (8–17)27237 (30–43)
    Empathy
        >11827 (14–48)1748 (29–68)
        130211 (8–15)29135 (29–42)
    Reflections
        Yes1229 (5–15)11846 (36–57)
        No19814 (10–20)19030 (24–37)
    Open questions
        Yes12110 (5–19)11538 (26–50)
        No19913 (9–19)19335 (28–42)
    MI behaviors
        Any MI adherent15711 (7–16)15234 (26–42)
        No MI adherent16313 (8–20)15638 (30–47)
        Any MI nonadherent26311 (7–16)25637 (30–44)
        No MI nonadherent5716 (8–30)5231 (21–43)

    • MI, motivational interviewing.

    • Bold indicates statistical significance.

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