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The Therapeutic Alliance

It is within the context of communication that the therapeutic alliance between physician and patient is formed. When communication with a patient is nonjudgmental, respectful, and genuine, the stage is set for a successful therapeutic alliance. Medical knowledge is vitally necessary, but alone it is insufficient to accomplish the tasks of caring for a patient. It is the ability of the physician to translate medical knowledge for the patient and to enlist the trust of the patient that will ultimately lead to good health care for the patient.

Good communication has several beneficial effects on the relationship between the physician and the patient. It improves patient satisfaction, adherence,1 and health. It also improves physicians' satisfaction with their work and the accuracy of information they obtain from patients and decreases the likelihood that physicians will be sued for malpractice.

1 The term adherence is used throughout this chapter in preference to compliance.

Patient Satisfaction

The impact of good communication on patient satisfaction is the best studied of these benefits. Ware and colleagues extensively reviewed the evidence for the validity of using patient satisfaction and other patient rating scales, concluding that patients' ratings of interpersonal aspects of care provide not only useful and valid information for quality assessment but also the best source of data on the interpersonal aspects of care.

Patients generally want more information than their physicians give them. The amount of information given to the patient strongly correlates with patient satisfaction. Physicians spend a small fraction of their time giving information, 1 minute out of 20, and believe that they spend more time than they actually do. Thus the correlation between the amount of information patients receive and their satisfaction with the visit is a strong and consistent observation in the medical literature.

Many other physician behaviors also correlate with satisfaction. These include courtesy, attention, listening, empathy, and sympathy. Patients whose physicians communicate and interpret emotions well and are friendly, concerned, take time to answer questions, and give explanations are more satisfied. Patients rate their physicians positively if they are encouraging, open, and attentive and negatively if they dominate the encounter.

Physicians' personal qualities are rated highly if the encounter centers on the patient rather than on the physician's concerns. Physicians who ask many directive questions and keep tight control over the interaction tend to have patients who feel that their physicians do not listen to them.

Buller MK, Buller DB: Physicians' communication style and patient satisfaction. J Health Soc Behav 1987;28:375.  [PubMed: 3429807]
Ware JE Jr, Hays RD: Methods for measuring patient satisfaction with specific medical encounters. Med Care 1988;26:393.  [PubMed: 3352332]

Physician Satisfaction

Physician satisfaction, although not as well studied as patient satisfaction, is very important for physicians' ...

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