Identification of Clinical Risk Factors Affecting Patient-Physician Communication

Published:November 01, 2022DOI:



      Patient satisfaction is an important indicator of quality in health care and is linked to clinical outcomes, patient retention, and professional satisfaction. Patients admitted to the hospital from the emergency department may not understand their diagnosis, reason for admission or plan of care, which can adversely impact their hospital experience. We aim to identify risk factors that contribute to poor patient-physician communication and to assess the effects of raising awareness of these issues to hospital providers.


      From November 2020 to April 2021, patients admitted to the surgical floor were surveyed within 24 h of admission. Relevant data were extracted through retrospective chart review. Residents and attendings were debriefed regarding the improving communication. Surveys answered before and after the brief intervention were compared.


      One hundred thirty one patients who were admitted to the surgical floor were surveyed. Nineteen did not know their diagnoses (14.5%), 29 could not explain their diagnoses (22.1%), and 28 did not know their treatment plans (21.4%). A total of 38 (29.0%) patients answered “no” to at least one question. Trauma patients (P = 0.034), patients with pain score >4 at time of admission (P = 0.038), age >65 y (P = 0.047), and patients with >3 comorbidities were more likely to answer “no” to at least one of the questions. Postintervention, a 10% reduction in number of patients answering “no” was observed.


      Trauma patients, patients with poor pain control, the elderly, and those with multiple comorbidities are more likely to experience poor patient-physician communication. Raising awareness of the importance of this matter resulted in an improvement in communication.


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        • Ong L.M.
        • de Haes J.C.
        • Hoos A.M.
        • Lammes F.B.
        Doctor-patient communication: a review of the literature.
        Soc Sci Med. 1995; 40: 903-918
        • Zolnierek K.B.
        • Dimatteo M.R.
        Physician communication and patient adherence to treatment: a meta-analysis.
        Med Care. 2009; 47: 826-834
        • Cooper L.A.
        • Roter D.L.
        • Johnson R.L.
        • Ford D.E.
        • Steinwachs D.M.
        • Powe N.R.
        Patient-centered communication, ratings of care, and concordance of patient and physician race.
        Ann Intern Med. 2003; 139: 907-915
        • van der Kop M.L.
        • Ojakaa D.I.
        • Patel A.
        • et al.
        The effect of weekly short message service communication on patient retention in care in the first year after HIV diagnosis: study protocol for a randomised controlled trial (WelTel Retain).
        BMJ Open. 2013; 3: e003155
        • Makayrus A.N.
        • Friedman E.A.
        Patients' understanding of their treatment plans and diagnosis at discharge.
        Mayo Clin Proc. 2005; 80: 991-994
        • Sudore R.L.
        • Landefeld C.S.
        • Pérez-Stable E.J.
        • Bibbins-Domingo K.
        • Williams B.A.
        • Schillinger D.
        Unraveling the relationship between literacy, language proficiency, and patient–physician communication.
        Patient Educ Couns. 2009; 75: 398-402
        • Cené C.W.
        • Roter D.
        • Carson K.A.
        • Miller E.R.
        • Cooper L.A.
        The effect of patient race and blood pressure control on patient-physician communication.
        J Gen Intern Med. 2009; 24: 1057-1064
        • Timmermans D.
        • Molewijk B.
        • Stiggelbout A.
        • Kievit J.
        Different formats for communicating surgical risks to patients and the effect on choice of treatment.
        Patient Educ Couns. 2004; 54: 255-263
        • Meredith P.
        Patient satisfaction with communication in general surgery: problems of measurement and improvement.
        Soc Sci Med. 1993; 37: 591-602
        • Meredith P.
        • Wood C.
        Inquiry into the potential value of an information pamphlet on consent to surgery to improve surgeon-patient communication.
        BMJ Qual Saf. 1998; 7: 65-69
      1. Communication. Merriam-webster.
        (Available at:)
        • Anderson K.M.
        • Leister S.
        • De Rego R.
        The 5Ts for teach back: an operational definition for teach-back training.
        Health Lit Res Pract. 2020; 4: e94-e103
        • Yen P.H.
        • Leasure A.R.
        Use and effectiveness of the teach-back method in patient education and health outcomes.
        Fed Pract. 2019; 36: 284-289
        • Ha J.F.
        • Longnecker N.
        Doctor-patient communication: a review.
        Ochsner J. 2010; 10: 38-43
        • Matusitz J.
        • Spear J.
        Effective doctor-patient communication: an updated examination.
        Soc Work Public Health. 2014; 29: 252-266
        • Lee S.J.
        • Back A.L.
        • Block S.D.
        • Stewart S.K.
        Enhancing physician-patient communication.
        Hematology Am Soc Hematol Educ Program. 2002; : 464-483
        • Honavar S.G.
        Patient-physician relationship - communication is the key.
        Indian J Ophthalmol. 2018; 66: 1527-1528
        • Braaf S.
        • Ameratunga S.
        • Nunn A.
        • et al.
        Patient-identified information and communication needs in the context of major trauma.
        BMC Health Serv Res. 2018; 18: 163
        • Tiwary A.
        • Rimal A.
        • Paudyal B.
        • Sigdel K.R.
        • Basnyat B.
        Poor communication by health care professionals may lead to life-threatening complications: examples from two case reports.
        Wellcome Open Res. 2019; 4: 7
        • Martino C.
        • Russo E.
        • Santonastaso D.P.
        • et al.
        Long-term outcomes in major trauma patients and correlations with the acute phase.
        World J Emerg Surg. 2020; 15: 6
        • Mistiaen P.
        • van Osch M.
        • van Vliet L.
        • et al.
        The effect of patient-practitioner communication on pain: a systematic review.
        Eur J Pain. 2016; 20: 675-688
        • Wyman M.F.
        • Shiovitz-Ezra S.
        • Bengel J.
        Ageism in the health care system: providers, patients, and systems.
        in: Contemporary Perspectives on Ageism. 19. Springer International Publishing, Cham2018: 193-212 (Available at:)
        • Ben-Harush A.
        • Shiovitz-Ezra S.
        • Doron I.
        • et al.
        Ageism among physicians, nurses, and social workers: findings from a qualitative study.
        Eur J Ageing. 2016; 14: 39-48
        • Bartlett G.
        • Blais R.
        • Tamblyn R.
        • Clermont R.J.
        • MacGibbon B.
        Impact of patient communication problems on the risk of preventable adverse events in acute care settings.
        CMAJ. 2008; 178: 1555-1562
        • Sen M.
        Communication with cancer patients. The influence of age, gender, education, and health insurance status.
        Ann N Y Acad Sci. 1997; 809: 514-524
        • Hall J.A.
        • Roter D.L.
        Patient gender and communication with physicians: results of a community-based study.
        Womens Health. 1995; 1: 77-95
        • Vermeir P.
        • Vandijck D.
        • Degroote S.
        • et al.
        Communication in healthcare: a narrative review of the literature and practical recommendations.
        Int J Clin Pract. 2015; 69: 1257-1267