IMPACT OF DOCTORS VERBAL AND NON-VERBAL COMMUNICATION ON PATIENTS

A PROJECT REPORT

Submitted by

ABIMANYU N.N. FELIX SWAGGART S. RAJAGOPAL B. SATHISH KUMAR T. TRAVEEN CHARLESTON J.

CONTENTS
ABSTRACT................................................................................................................................ 3 LIST OF FIGURES .................................................................................................................... 4 LIST OF TABLES ...................................................................................................................... 4

1. INTRODUCTION................................................................................................................... 5 2. LITERATURE REVIEW ....................................................................................................... 5 3. DATA ANALYSIS .................................................................................................................. 6 3.1 APPEARANCE AND BEHAVIOUR OF THE DOCTOR ......................................................... 6 3.2 LOCAL DIALECT AND REPUTATION OF THE DOCTOR .................................................. 7 3.3 COMMUNICATION IMPROVEMENT IF PATIENT IS ACCOMPANIED ........................... 8 3.4 DOCTORS CONVEYANCE OF THE AILMENTS ................................................................. 8 3.5 EFFECT OF DOCTORS GENDER, FAMILIARITY OF THE DOCTOR AND PATIENTS MOOD ON COMMUNICATION ..................................................................................................... 9 3.6 BARRIERS AFFECTING COMMUNICATION ..................................................................... 10 3.7 DOCTORS & COMMUNICATION SKILLS TRAINING ...................................................... 11

4. CONCLUSION ..................................................................................................................... 12

REFERENCES ......................................................................................................................... 13

ABSTRACT
Background and Purpose Communication between doctors and patients is getting increased attention in the health care industry, given the effect that it can have on patients, mentally and physically. The purpose of this research is to identify the impact of the doctors verbal and non-verbal communication on patients in the healthcare industry.

Sources and Methods A literature review was done through which the variables that could be used to identify the impact of the doctors verbal and non-verbal communication on patients were fixed. A questionnaire was prepared using these variables. The questionnaire was completed by 99 patients from the private clinics in Coimbatore.

Limitations The results of the study are applicable only to the city of Coimbatore as the samples are representative of Coimbatore city only The questionnaire was in English and many respondents wanted to know what the questions meant in local vernacular which might have led to a slight distortion in their answers. The patients surveyed were not in the best physical health while answering the questionnaire.

LIST OF FIGURES
1. Barriers Affecting Communication 2. Communication Improvement & Doctors Communication Training

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LIST OF TABLES
1. Appearance of Doctor 2. Behaviour of Doctor 3. Doctors Speaking Local Dialect 4. Reputation of Doctor 5. Communication Improvement When Patient Is Accompanied 6. Conveyance of the Ailments 7. One Sample Statistics 8. One Sample Test 9. Chi-Square Test Statistics 6 6 7 7 8 8 9 9 10

1. INTRODUCTION
The doctor patient relationship is a very sensitive one and it requires a complete understanding of communication from either one of them to make the relationship work effectively. This report deals with the impact of doctors verbal and non-verbal communication on patients. Factors like appearance, behaviour, smile, local dialect, reputation of the doctor were taken into account. Other factors like gender of the doctor, mood of the patient, familiarity of the doctor were rated on a scale of 1 to 5.

2. LITERATURE REVIEW
The following literatures were referred with respect to the report. Communicating With Patients: What Happens In Practice, by Lisa Roberts, Sally and Bucksey provided information on prevalence of verbal and non-verbal communications between physical therapists and patients with back pain. The fact that non-verbal communication skills of the physicians bore little relationship to patients ratings of the technical quality of care was reported by the paper Predicting Patient Satisfaction from Physicians Nonverbal Communication Skills, by M. Robin DiMatteo, Angelo Taranta, Howard S. Friedman and Louise M. Prince. Another paper, Effective Physician-Patient Communication And Health Outcomes: A Review, by Moira A. Stewart ascertained whether the quality of physician-patient communication makes a significant difference to the patient health outcomes. Patients satisfaction level changes after the participation of the doctor in a brief educational intervention on medicolegal risk management was examined in the paper Communication Skills Training For Doctors Increases Patient Satisfaction, by Stephen C. Trumble, Mark L. OBrien, Matthew OBrien and Bronwyn Hartwig.

3. DATA ANALYSIS
The respondents surveyed were in the age group of 21 to above 50. A total of 99 respondents were surveyed. The gender wise sample consisted of 41.4% females and 58.6% males.

3.1 APPEARANCE AND BEHAVIOUR OF THE DOCTOR

The survey results indicate that 35.4% of the patients believe that the appearance of the doctor affects the patients communication sometimes whereas 20.2% of the patients believe that it does not affect communication at all. Table 1 : Appearance of doctor Frequency Sometimes Occassionally Always Never Often Total 35 11 8 20 25 99 Percent 35.4 11.1 8.1 20.2 25.3 100.0 Valid Percent 35.4 11.1 8.1 20.2 25.3 100.0 Cumulative Percent 35.4 46.5 54.5 74.7 100.0

On the other hand, behaviour always affects the communication, 31.3% patients feel. Only 8.1% of the patients did not accept that behaviour of the doctor affected the patients communication. Table 2 : Behaviour of doctor Cumulative Percent 12.1 43.4 51.5 82.8 100.0

Frequency Occassionally Always Never Often Sometimes Total 12 31 8 31 17 99

Percent 12.1 31.3 8.1 31.3 17.2 100.0

Valid Percent 12.1 31.3 8.1 31.3 17.2 100.0

3.2 LOCAL DIALECT AND REPUTATION OF THE DOCTOR

Surprisingly, 29.3% of the patients sometimes preferred communicating with doctors who did not speak the local dialect. Only 6% of the patients always preferred doctors who spoke local dialect.

Table 3 : Doctors Speaking Local Dialect

Frequency Occassionally Always Never Often Sometimes Total 25 6 27 12 29 99

Percent 25.3 6.1 27.3 12.1 29.3 100.0

Valid Percent 25.3 6.1 27.3 12.1 29.3 100.0

Cumulative Percent 25.3 31.3 58.6 70.7 100.0

The reputation of the doctor plays a significant role in the communication of the patient as 34% of the patients often felt that the reputation of the doctor affected their communication. Only 6% were unaffected by the doctors reputation. Table 4 : Reputation of doctor

Frequency Sometimes Occassionally Always Never Often Total 28 12 19 6 34 99

Percent 28.3 12.1 19.2 6.1 34.3 100.0

Valid Percent 28.3 12.1 19.2 6.1 34.3 100.0

Cumulative Percent 28.3 40.4 59.6 65.7 100.0

3.3 COMMUNICATION IMPROVEMENT IF PATIENT IS ACCOMPANIED

20.2% of the patients felt that if somebody accompanied them to the doctors, then their communication improved. Only 9.1% of the patients felt that accompaniment had no effect on their communication. Table 5 : Communication Improvement when patient is accompanied Cumulative Frequency Percent Valid Percent Percent Occassionally Always Never Often Sometimes Total 16 20 9 24 30 99 16.2 20.2 9.1 24.2 30.3 100.0 16.2 20.2 9.1 24.2 30.3 100.0 16.2 36.4 45.5 69.7 100.0

3.4 DOCTORS CONVEYANCE OF THE AILMENTS

An overwhelming 44.4% of the patients felt that doctors always made sure that patients understood their ailments. The doctors are thus effective in relaying the patients ailments effectively. Table 6 : Conveyance of the Ailments Cumulative Frequency Percent Valid Percent Percent Occassionally Always Often Sometimes Total 1 44 43 11 99 1.0 44.4 43.4 11.1 100.0 1.0 44.4 43.4 11.1 100.0 1.0 45.5 88.9 100.0

3.5 EFFECT OF DOCTORS GENDER, FAMILIARITY OF THE DOCTOR AND PATIENTS MOOD ON COMMUNICATION
Factors like doctors gender, familiarity of the doctor with respect to the patient and the patients mood were given a rating scale of 1 to 5. The following results were arrived at after applying the one sample t-test and chi-square test.

Table 7 : One-Sample Statistics Std. Deviation 1.30939 1.49892 1.21634 Std. Error Mean .13160 .15065 .12225

N Gender of Doctor Familiarity of doctor Mood of patient 99 99 99

Mean 2.5859 3.4242 3.1010

For the one sample t-test, a test value of 3 was selected. The mean difference of gender of the doctor was lesser than the sample mean while the mean difference of familiarity of the doctor and mood of the patient were greater than the sample mean. The standard error mean of all the three factors are depicted in the above table 7. Table 8 : One-Sample Test

Test Value = 3 95% Confidence Interval of the Difference Sig. (2tailed) 98 .002 Mean Difference -.41414

t Gender of Doctor Familiarity of doctor Mood of patient -3.147

df

Lower -.6753

Upper -.1530

2.816 .826

98 98

.006 .411

.42424 .10101

.1253 -.1416

.7232 .3436

The Chi-square test indicates that there are no significant differences in all the three factors i.e. gender of the doctor, familiarity of the doctor and the mood of the patient which affect the communication of the patients. The degree of freedom for all the three factors is 4 whereas the p value for gender of the doctor and mood of the patient is 0.034. p value for the familiarity of the doctor is just 0.004. Table 9 : Chi-Square Test Statistics ChiSquare Gender of Doctor Familiarity of doctor Mood of patient 10.444a 15.596a 10.444a df 4 4 4 Asymp. Sig. .034 .004 .034

a. 0 cells (.0%) have expected frequencies less than 5. The minimum expected cell frequency is 19.8.

3.6 BARRIERS AFFECTING COMMUNICATION

The barriers affecting communication were offered as multiple answers for one question. The following results were obtained from the survey. Time constraint was the major reason cited by 61 of the respondents for lack of proper communication. Speech ability seemed to hinder 38 of the respondents. These were the two major barriers. The other two barriers, foreign language and gender difference played minor roles in affecting the communication of the patients. Figure 1 : Barriers Affecting Communication Barriers Affecting Communication
70 60 50 40 30 20 10 0 Time Constraint Speech Ability Foreign Language Gender Difference Barriers Affecting Communcation

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3.7 DOCTORS & COMMUNICATION SKILLS TRAINING

On whether the doctors should be given training on communication skills, 76.8% of the respondents wanted the doctors to undergo the training while 23.3% felt that training was unnecessary. When the respondents were queried about the improvement of the doctors communication skills in the recent years, 80.8% of them replied that communication has certainly improved but 19.2% of the respondents were sceptical about the improvement. Figure 2 : Communication Improvement & Doctors Communication Training

19.2 Communication Improvement 80.8 No Yes 23.2 Doctors Communication Training 76.8

20

40

60

80

100

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4. CONCLUSION
From the survey, a doctors verbal and non-verbal communication plays a vital role in the healthcare industry by influencing a patients communication. Speech ability and time constraint are the main barriers which affect communication. Other factors like gender of the doctor, mood of the patient and familiarity of the doctor significantly affected the patients communication as proved by the t-test and chi-square test. The doctors can improve their communication skills, both verbal and non-verbal by attending training sessions.

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REFERENCES
1. Lisa Roberts, Sally and Bucksey, Communicating With Patients: What Happens In Practice?, Research Report, 2007. 2. M. Robin DiMatteo, Angelo Taranta, Howard S. Friedman and Louise M. Prince, Predicting Patient Satisfaction from Physicians Nonverbal Communication Skills,Medical Care, Vol 18, No. 4, April 1980. 3. Moira A. Stewart, Effective Physician-Patient Communication And Health Outcomes: A Review, Canadian Medical Association, May 1 1995. 4. Stephen C. Trumble, Mark L. OBrien, Matthew OBrien and Bronwyn Hartwig, Communication Skills Training For Doctors Increases Patient Satisfaction, Clinical Governance: An International Journal, Vol 11, No. 4, 2006.

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