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Saturday, May 11, 2013

Physicians build less rapport with obese patients

By K.A. Gudzune, M.C. Beach, D.L. Roter, & L.A. Cooper
Obesity (Silver Spring). 2013 Mar 20. doi: 10.1002/oby.20384.

Abstract

Objective: 
Physicians' negative attitudes towards patients with obesity are well documented. Whether or how these beliefs may affect patient-physician communication is unknown. We aimed to describe the relationship between patient BMI and physician communication behaviors (biomedical, psychosocial/lifestyle, and rapport building) during typical outpatient primary care visits.

Design and Methods: 
Using audio-recorded outpatient encounters from 39 urban PCPs and 208 of their patients, we examined the frequency of communication behaviors using the Roter Interaction Analysis System. The independent variable was measured patient BMI and dependent variables were communication behaviors by the PCP within the biomedical, psychosocial/lifestyle, and rapport building domains. We performed a cross-sectional analysis using multilevel Poisson regression models to evaluate the association between BMI and physician communication.

Results: 
PCPs demonstrated less emotional rapport with overweight and obese patients (IRR 0.65, 95%CI 0.48-0.88, p=0.01; IRR 0.69, 95%CI 0.58-0.82, p<0.01, respectively) than for normal weight patients. We found no differences in PCPs' biomedical or psychosocial/lifestyle communication by patient BMI.

Conclusions:
Our findings raise the concern that low levels of emotional rapport in primary care visits with overweight and obese patients may weaken the patient-physician relationship, diminish patients' adherence to recommendations, and decrease the effectiveness of behavior change counseling.

And, click here for a blog post on this article, with the excerpt below:

Are Doctors Nicer to Thinner Patients?

By TARA PARKER-POPE
The New York Times - Well Column
Originally published April 29, 2013

Here is an excerpt:

“When there is increased empathy by the doctor, patients are more likely to report they are satisfied with their care, and they are more likely to adhere to recommendations of physicians,” Dr. Gudzune said. “There is evidence to show that after visits with more empathy, patients have improved clinical outcomes, so patients with diabetes have better blood sugar control or cholesterol is better controlled.”

Dr. David L. Katz, director of the Yale-Griffin University Prevention Research Center, says that overweight patients often complain to him that doctors appear judgmental about their weight, at the expense of other health concerns.

“You come in with a headache, and the doctors say, ‘You really need to lose weight.’ You have a sore throat, and the doctor says, ‘You really need to lose weight,’ ” he said. “These patients feel like the doctor doesn’t help them and they insult them, and so they stop going.”

In dealing with patients who are overweight, Dr. Katz added, doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.

“When we can’t fix what is broken we tend to behave badly,” he said.