Patient-centered communication during primary care visits for depressive symptoms: what is the role of physician personality?

摘要

BACKGROUND: Patient-centered communication (PCC) is associated with more appropriate treatment of depression in primary care. Aside from patient presentation, little is known about other influences on PCC. We investigated whether PCC is influenced by personality dispositions of primary care providers, independent of patient presentation. METHODS: Forty-six primary care providers completed personality scales from the NEO-Personality Inventory, revised and provided care to 88 standardized patients presenting with either major depression or adjustment disorder with comorbid musculoskeletal symptoms, either making or not making a medication request. Coders scored each visit using the measure of PCC, assessing physicians' ability to explore the patient's illness experience (component 1), understand the patient's psychosocial context (component 2), and involve the patient in collaborative discussions of treatment (component 3). RESULTS: Adjusting for physician demographics, training, and patient presentation, physicians who were more open to feelings explored the patient's experience of illness more (P = 0.05). More dutiful, or rule-bound physicians engaged in greater exploration of the patient's psychosocial and life circumstances (P = 0.04), but involved the patient less in treatment discussions (P = 0.03). Physicians reporting more anxious vulnerability also involved the patient less (P = 0.03). Physician demographics, training, and patient presentation explained 4-7% of variance in the measure of patient-centered communication components, with personality explaining an additional 4-7% of the variance. CONCLUSIONS: Understanding of personality dispositions that promote or detract from PCC may help medical educators better identify trainees of varying aptitude, facilitate medical career counseling, and address individual training needs in a tailored fashion.