The impact of clinical encounter events on patient and physician satisfaction

This study explored levels of patient and physician satisfaction as a function of events which occur during the clinical encounter. Data which are directly observable (verbal and nonverbal) and obtainable through interviews were considered. Eighty-eight encounters were observed over a one-week period at an outpatient clinic of a university-affiliated hospital. Participants were interviewed subsequent to each interaction. Multiple discriminant analysis showed encounters viewed by patients as relatively unsatisfactory to be characterized by greater distance between parties during information gathering, increased amounts of feedback, highly active physicians, and physicians who were on call. Satisfied patients had encounters marked by increased physician use of (1) nonverbal encouragement, (2) questions about family and social situations, and (3) expressions of continuity from previous visits. Physicians were less satisfied in encounters in which they were active, felt pressed to other medical commitments, and were on call. The most positive physician assessments occurred when patients were seen as compliant and where humor and nonverbal encouragement were used during the interaction. These data suggest variables which are generally amenable to change if physicians are made aware of their potential impact.