title: Physician burnout and patient-physician communication during primary care encounters.
abstract: BACKGROUND
  Although previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies relate physician burnout to observed patient-physician communication behaviors.
  
  
  OBJECTIVE
  To investigate the relationship between physician burnout and observed patient-physician communication outcomes in patient-physician encounters.
  
  
  METHODS
  Longitudinal study of enrollment data from a trial of interventions to improve patient adherence to hypertension treatment.
  
  
  METHODS
  Fifteen urban community-based clinics in Baltimore, MD.
  
  
  METHODS
  Forty physicians and 235 of their adult hypertensive patients, with oversampling of ethnic minorities and poor persons. Fifty-three percent of physicians were women, and the average practice experience was 11.2 years. Among the 235 patients, 66% were women, 60% were African-American, and 90% were insured.
  
  
  METHODS
  Audiotape analysis of communication during outpatient encounters (one per patient) using the Roter Interaction Analysis System and patients' ratings of satisfaction with and trust and confidence in the physician.
  
  
  RESULTS
  The median time between the physician burnout assessment and the patient encounter was 15.1 months (range 5.6-30). Multivariate analyses revealed no significant differences in physician communication based on physician burnout. However, compared with patients of low-burnout physicians, patients of high-burnout physicians gave twice as many negative rapport-building statements (incident risk ratio 2.06, 95% CI 1.58-2.86, p < 0.001). Physician burnout was not significantly associated with physician or patient affect, patient-centeredness, verbal dominance, or length of the encounter. Physician burnout was also not significantly associated with patients' ratings of their satisfaction, confidence, or trust.
  
  
  CONCLUSIONS
  Physician burnout was not associated with physician communication behaviors nor with most measures of patient-centered communication. However, patients engaged in more rapport-building behaviors. These findings suggest a complex relationship between physician burnout and patient-physician communication, which should be investigated and linked to patient outcomes in future research.
authors.affiliation: Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason Lord Building Center Tower, 5200 Eastern Avenue, Suite 2300, Baltimore, MD 21224, USA. neda@jhmi.edu
authors.forename: Neda
authors.initials: N
authors.lastname: Ratanawongsa
authors.forename: Debra
authors.initials: D
authors.lastname: Roter
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Beach
authors.forename: Shivonne L
authors.initials: SL
authors.lastname: Laird
authors.forename: Susan M
authors.initials: SM
authors.lastname: Larson
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Carson
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000523:psychology*; D015331:Cohort Studies; D003142:Communication; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology* / Q000639:trends; D011320:Primary Health Care / Q000379:methods* / Q000639:trends; D016032:Randomized Controlled Trials as Topic / Q000639:trends