The manifestation of job satisfaction in doctor-patient communication; a ten-country European study

Article Sidebar

Requires Subscription or Fee PDF (USD 25)
Published: Jul 30, 2013
DOI: https://doi.org/10.5750/ijpcm.v3i1.381
Keywords:
Affective climate European countries eye gaze gender general practice job satisfaction verbal communication

Main Article Content

J.M. Bensing
NIVEL (Netherlands institute for health services research), Utrecht
A. van den Brink-Muinen
NIVEL (Netherlands institute for health services research), Utrecht
W. Boerma
NIVEL (Netherlands institute for health services research), Utrecht
Sandra van Dulmen

Abstract

Objective: Job satisfaction is a common problem in modern western health care. While a lot of studies analyzed the determinants of job (dis)satisfaction, less is known about the consequences of doctors’ job satisfaction for medical visits. The aim of this study is to examine - female and male - General Practitioners’ (GPs) satisfaction with their work in 10 European countries and to analyze whether the level of satisfaction manifests itself in the communication with their patients.Methods: Data used were from two EU-funded studies together covering ten countries: the Netherlands, United Kingdom, Spain, Belgium, Germany, Switzerland, Sweden, Estonia, Poland and Rumania. 302 GPs (165 male; 137 female) and 4446 patients (1756 male; 2690 female) gave written consent to videotape their consultation and completed short questionnaires. Videotaped consultations were analyzed on verbal communication, percentage patient-directed gaze and general affect measures. Data were analyzed at the aggregated GP-level; a multilevel model was used to check country-specific influences.Results: Job satisfaction differed slightly between countries. In most countries female GPs were more satisfied than men. Job satisfaction was clearly reflected in GPs’ and patients’ communication, both showing more verbal and nonverbal affect and talking more about psychosocial issues the higher the job satisfaction of the GP.Discussion: There is reciprocity between doctors’ and patients’ way of communicating, mediated by doctors’ job satisfaction and reflected in the affective atmosphere of the consultation.Conclusions: Although this study gives no indication of cause and effect, we may conclude that GPs’ job satisfaction does impact doctor-patient communication. This may foster research into determinants of job satisfaction that are amenable to change and may inspire intervention studies aimed at increasing job satisfaction.

Article Details

Issue
Vol. 3 No. 1 (2013)
Section
Regular Articles
Author Biography

Sandra van Dulmen

A.M. (Sandra) studied clinical psychology. After graduation in 1997 (cum laude), she started working as a researcher in different fields of health care, first at the Department of Clinical Psychology, then from 1988-1995, at the Department of General Practice at the University of Nijmegen. She obtained her PhD degree in 1996 with the thesis titled “Exploring cognitions in irritable bowel syndrome; implications for the role of the doctor”. For her thesis she received the dissertation award from the Netherlands School of Primary Care Research (CaRe). From 1995 onwards she works at NIVEL (Netherlands institute for health services research), first as a researcher, since 1999 as the co-ordinator of the research program Communication in Healthcare. In 2001 she was co-founder and since then the secretary of EACH (European Association for Communication in Healthcare). She obtained numerous grants for her communication studies, varying from observational research in general practices and hospitals to intervention studies among medical students, specialists, nurses as well as among patients with minor ailments, type 1 or type 2 diabetes, IBS, or cancer. A core feature of her work is the (video)observation and analysis of the communication in the consulting room between a patient and a health care professional. She collaborates within several international research projects. Currently Sandra van Dulmen supervises seven PhD students. She has published around 50 national and 100 international papers in peer-reviewed journals. A selection of these include:Oerlemans S, Van Cranenburgh O, Herremans P-J, Spreeuwenberg P, Van Dulmen S. Intervening on cognitions and behaviour in irritable bowel syndrome: a feasibility trial using PDAs. J Psychosom Res 2011 (in press)Weert J van, Jansen J, Spreeuwenberg P, Dulmen S van, Bensing J. Effects of a Communication Skills Training to improve Communication with Older Cancer Patients: A Randomized controlled trial . Critical Reviews in Oncology/Hematology 2011 (in press)Noordman J, Verhaak P, I. van Beljouw I van, Dulmen S van. Discussing patient’s (un)healthy lifestyle in the consulting room: analysis of GP-patient consultations between 1975 and 2008. BMC Fam Pract 2010; 11(1): 87Dulmen S van, Groot J de, Koster D, Heiligers Ph. Why seek complementary medicine? An observational study in homeopathic, acupunctural and naturopathic medical practices. Journal of Complementary and Integrative Medicine 2010; 7: 20Albada A, Dulmen S van, Otten R, Bensing JM, Ausems MGEM. The development of E-info geneca: a computer-tailored intervention prior to breast cancer genetic counselling. J Gen Couns 2009; 18: 326-338Morren M, Dulmen S van, Ouwerkerk J,  Bensing J. Compliance with momentary pain measurement using electronic diaries: A systematic review. Eur J Pain 2009; 13: 354-365Dulmen S van, Tromp F, Grosfeld F, Cate Th J ten, Bensing JM. The impact of assessing simulated bad news consultations on medical students’ stress response and communication performance. Psychoneuroendocrinology 2007;  32: 943–950Zwaanswijk M, Tates K, Dulmen S van, Hoogerbrugge PM, Kamps W, Bensing J. Young patients’, parents’, and survivors’ communication preferences in paediatric oncology: Using online focus groups to develop a structured questionnaire. BMC Pediatrics 2007; 7: 35Dijk L van, Heerdink ER, Somai D, Dulmen AM van, Ridder DT de, Sluijs EM, Griens AMGF, Bensing JM. Patient risk profiles and practice variation in nonadherence to antidepressants, antihypertensives and oral hypoglycemics. BMC Health Serv Res. 2007 Apr 10;7(1):51Dulmen S van, Sluijs E, Dijk L van, Ridder D de, Heerdink R, Bensing J. Patient Adherence to medical treatment: a review of reviews. BMC Health Services Research. BMC Health Services Research 2007, 7:55 

References

Appleton K, House A, Dowell A. (1998). A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds. British Journal of General Practice, 48, 1059-1063.

Sutherland VJ, Cooper CL. (1992). Job stress, satisfaction and mental health among genera; practitioners before and after introduction of new contract. British Medical Journal, 304, 1545-1548.

Chambers R, Belcher J. (1993). Work patterns of general practitioners before and after the introduction of the 1990 contract. British Journal of General Practice, 43, 410-412.

Leese B, Bosanquet N. (1996). Changes in general practice organization: survey of general practitioners’ views on the 1990 contract and fundholding. British Journal of General Practice, 46, 95-99.

Sibbald B, Enzer I, Cooper C, Rout U, Sutherland V. (2000). GP job satisfaction in 1987, 1990 and 1998: lessons for the future? Family Practice, 17, 364-371.

Scott A, Wordsworth S. (1999). The effects of shifts in the balance of care on general practice workload. Family Practice, 16, 12-17.

Bailie R, Sibthorpe B, Douglas B, Broom D, Atewell R, McGuiness C. (1998). Mixed feelings: satisfaction and disillusionment among Australian GPs. Family Practice, 15, 58-66.

Murray A, Montgomery JE, Chang H, Rogers WH, Inui T, Safran DG. (2001). Doctor discontent. A comparison of physician satisfaction in different delivery settings, 1986 and 1997. Journal of General Internal Medicine, 16, 496-497.

Magee M, Hojat M. (2001). Impact of health care system on physicians’ discontent. Journal of Community Health, 26, 357-365.

Cohen M, Ferrier B, Woodward CA, Brown J. (2001). Health care system reform. Ontario family physicians’ reactions. Canadian Family Physician, 47, 1777-1784.

Dowell AC, Hamilton S, McLeod DK. (2000). Job satisfaction, psychological morbidity and job stress among New Zealand general practitioners. The New Zealand Medical Journal, 113, 269-272.

Forsberg E, Axelsson R, Arnetz B. (2001). Effects of performance-based reimbursement on the professional autonomy and power of physicians and the quality of care. The International Journal of Health Planning and Management, 16, 297-310.

Post D. (2002). Groeiend ongenoegen: een onderzoek onder huisartsen. Medisch Contact, 57, 63-65.

Ferriman, A. (2001). Doctors explain their unhappiness. British Medical Journal, 322:1197

Dowie J. (2001). Decision technologies and the independent professional: the future's challenge to learning and leadership. Quality in Health Care, 10 Suppl 2: ii59-63.

Smith R. (2001). Why are doctors so unhappy? There are probably many causes, some of them deep. British Medical Journal, 322, 1073-1074.

Chew M. Williams A. (2001). Australian general practitioners desperately seeking satisfaction (ed). Medical Journal of Australia, 175: 85-86.

Grieve, S. (1997). Measuring morale - does practice area deprivation affect doctors’ well-being? British Journal of General Practice, 47, 547-552.

Krebs EE, Garrett JM, Konrad TR. (2006). The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data. BioMed Central Health Services Research. Oct 6;6:128.

Williams ES, Konrad TR, Linzer M, McMurray J, Pathman DE, Gerrity M, Schwartz MD, Scheckler WE, Douglas J. (2004). Physician, Practice, and Patient Characteristics Related to Primary Care Physician Physical and Mental Health: Results from the Physician Worklife Study. Health Services Research, 37, 119-141.

Pathman DE, Konrad TR, Williams ES, Scheckler WE, Linzer M, Douglas J. (2002). Physician job satisfaction, dissatisfaction, and turnover. The Journal of Family Practice, 51, 593.

Grol R, de Maeseneer J, Whitfield M, Mokkink H. (1990). Disease-centred versus patient-centred attitudes: comparison of general practitioners in Belgium, Britain and the Netherlands. Family Practice, 7, 100-103.

Grol R, Mokkink H, Smits A, van Eijk J, Beck M, Mesker P, Mesker-Niestern J. (1985). Work satisfaction of general practitioners and the quality of patient care. Family Practice, 2, 128-135.

DeVoe, J, Fryer GE, Hargraves L, Phillips RL, Green L. (2002). Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care? The Journal of Family Practice, 51, 223-228.

Grumbach K, Osmond D, Vranizan K, Jaffe D, Bindman AB. (1998). Primary care physicians’ experience of financial incentives in managed care systems. New England Journal of Medicine, 339, 1516-1521.

Mathers N, Jones N, Hannae D. (1995). Heartsink patients: a study of their general practitioners. British Journal of General Practice, 45, 293-296.

Zantinge EM, Verhaak PFM, Bakker DH de, Meer K van der, Bensing JM. (2009). Does burnout among doctors affect their involvement in patients' mental health problems? A study of videotaped consultations. BioMed Central Family Practice, 10:60

Tsimtsiou Z, Benos A, Garyfallos AA, Hatzichristou D. (2012). Predictors of physicians' attitudes toward sharing information with patients and addressing psychosocial needs: a cross-sectional study in Greece. Health Communication, 27, 257-263.

Haes H de, Bensing J. (2009). Endpoints in medical communication research, proposing a framework of functions and outcomes. Patient Education and Counseling, 74, 287-294.

Engel G. (1988). How much longer must medicine’s science be bound by a seventeenth century world view? In: L. K. White. The Task of Medicine: dialogue at Wickenburg. Menlo Park, California. The Henri Kaiser Family Foundation, 1988.

Bensing JM, Verhaak PFM. (2004). Communication in medical encounters: Towards a health psychology perspective in: A. Kaptein / J. Weinman, (eds). Health Psychology, an introduction. Blackwell, Oxford, 261-288.

Roter DL, Hall JA. (2006). Doctors talking with patients / patients talking with doctors. Improving communication in medical visits. (2nd revised edition). Praeger, Westport.

Blasi Z di, Harkness E, Ernst E, Georgiou A, Kleijnen J. (2001). Influence of context effects on health outcomes: a systematic review. The Lancet, 357, 757-762.

Handysides S. (1994). Enriching careers in general Practice: morale in general practice: is change the problem or the solution? British Medical Journal, 308, 32-34.

Piko BF. (2006). Burnout, role conflict, job satisfaction and psychosocial health among Hungarian health care staff: a questionnaire survey. International Journal of Nursing Studies, 43, 311-318.

Winefield HR, Anstey TJ. (1991). Job stress in general practice: practitioners’ age, sex and attitudes as predictors. Family Practice, 8, 140-144.

Maslach C, Schaufeli WB, Leiter MP. (2001). Job burnout. Annual Review of Psychology, 52, 397-422.

Brink-Muinen A van den, Dulmen AM van, Messerli-Rohrbach V, Bensing JM. (2002). Do gender-dyads have different communication patterns? A comparative study in Western European general practices. Patient Education and Counseling, 48, 253-264.

Van den Brink-Muinen, Verhaak PFM, Bensing JM, Bahrs O, Deveugele M, Gask L, Mead N, Leiva-Fernandez F, Messerli-Rohrbach V, Oppizzi L, Peltenburg M, Perez A. (1999). The Eurocommunication study; an international comparative study in six European countries on doctor-patient communication in general practice. Utrecht, NIVEL.

Van den Brink-Muinen A, van Dulmen AM, Bensing JM, Maaroos HI, Tähepöld H, ZJ, Plawecki L, S.C. Oana SC, Boros M, Satterlund-Larsson U, Bengtsson BM. (2003a). Eurocommunication II: a comparative study between countries in Central- and Western Europe on doctor-patient communication in general practice: final report. Utrecht, NIVEL.

Van den Brink-Muinen A., Verhaak PFM, Bensing JM, Bahrs O, Deveugele M, Gask L., Mead N, Leive-Fernandez F, Perez A, Messerli V, Oppizzi L, Peltenburg.M. (2003b). Communication in general practice: differences between European countries. Family Practice, 20, 478-485.

Deveugele M, Derese A, van den Brink-Muinen A, Bensing J, De Maeseneer J. (2002). Consultation length in general practice: cross sectional study in six European countries. British Medical Journal, 325(7362):472.

Peltenburg M, Fischer JE, Bahrs O, van Dulmen S, van den Brink-Muinen A. (2004). The unexpected in primary care: a multicenter study on the emergence of unvoiced patient agenda. The Annals of Family Medicine, 2, 534-540.

Boerma, WGW, van der Zee, J, Fleming, DM. (1997). Service profiles of general practitioners in Europe. British Journal of General Practice, 47, 481-486.

Dulmen S van, Humphris G, Eide H. (2012). Towards a guideline for person-centered research in clinical communication; lessons learned from three countries. International Journal of Person Centered Medicine, 2, 58-63.

[46] Melville, A. (1980). Job satisfaction in general practice: implications for prescribing. Social Science and Medicine, 14a, 495-499.

Roter, DL (1991). The Roter Method of Interaction Process Analysis. RIAS Manual. Johns Hopkins University, Baltimore.

Bensing JM. (1992). Instrumental and affective aspects of physician behavior. Medical Care, 30, 283-297.

Calnan M, Rowe R. (2006). Researching trust relations in health care: conceptual and methodological challenges-introduction. Journal of Health Organization and Management, 20, 349-58.

Suchman AL. (2006). A new theoretical foundation for relationship-centered care. Complex responsive processes of relating. Journal of General Internal Medicine, 21, S40–44.

Bensing JM, Kerssens JJ, van der Pasch M. Patient-directed gaze as a tool for discovering and handling psychosocial problems in general practice. Journal of Nonverbal Behavior 1995; 19: 223-242

Bensing JM, Schreurs K, de Rijk A. (1996). The role of physician's affective behaviour in medical encounters. Psychology and Health, 11, 825-838.

Hall JA, Roter DL. Katz NR. (1988). Meta-analysis of correlates of provider behavior in medical encounters. Medical Care, 26, 657.

Levinson W, Roter DL, Mullooly J, Dull V, Frankel R. (1997). Doctor-patient communication: a critical link to malpractice in surgeons and primary care physicians. The Journal of the American Medical Association, 277, 553-559.

Kaplan S. H., Greenfield S. and Ware J. E. (1989). Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Medical Care 27, Sll0.

Street RL Jr, Gordon H, Haidet P. (2007). Physicians' communication and perceptions of patients: is it how they look, how they talk, or is it just the doctor? Social Science and Medicine, 65, 586-598.

Kubacki A. (2003). What is important in the doctor-patient relationship? Journal of the Royal Society of Medicine, 96, 314.

Hall J, Horgan TG, Stein T, Roter DL. (2002). Liking in the physician-patient relationship. Patient Educ Couns, 48, 69-77.

Sixma H. Spreeuwenberg P. (2004). Het verband tussen de oordelen van patiënten over de kwaliteit van de huisartsenzorg, patiëntkenmerken en huisartskenmerken. In: Kwaliteit Huisartsenzorg belicht (ed. Braspenning J, Schellevis F, Grol, R.). Utrecht/Nijmegen, WOK/NIVEL.

Bakker AB, Schaufeli WB, Sixma HJ, Bosveld W, van Dierendonck D. (2000). Patient demands, lack of reciprocity and burnout: a five year longitudinal study about general practitioners. Journal of Organizational Behavior, 425-441.