title: How patients perceive a doctor's caring attitude.
abstract: OBJECTIVE
  Caring is closely associated with reduced malpractice litigation, adherence to treatment and even symptom relief. Caring also is included in pay for performance formulas as well as widely utilized for quality improvement purposes. Our objective in this prospective qualitative study was to define caring behaviors associated with three challenging encounters: discussing the transition from curative to palliative care, delivering bad news (cancer), and discussing a medical error (misplaced test result). The purpose was to lay the groundwork for the creation of a 'patient-centered' caring attitude checklist that could help the healthcare provider understand and ultimately enhance the patient's experience of care.
  
  
  METHODS
  Groups of randomly selected lay people, henceforth referred to as patients: (1) engaged in 'think aloud' exercises to help create a 15-item caring behavior checklist; (2) used the checklist to rate videotapes of simulated challenging encounters conducted by twenty primary care physicians (total of 600 ratings sets); and (3) participated in 12 separate 1.5 h focus groups discussing the caring (and non-caring) behaviors exhibited in videotapes of the highest and lowest rated encounters.
  
  
  RESULTS
  Thirteen behaviors emerged as focal for describing a doctor's caring attitude but with disagreement as to whether specific examples of these behaviors were 'caring' or 'uncaring.' For example, although the concept of empathic inquiry was considered important by most patients, the physician question, "Is there someone you can call or talk with" (about a cancer diagnosis) was interpreted by one patient as 'very caring' while another was 'impressed with how uncaring' the statement appeared.
  
  
  CONCLUSIONS
  At the conceptual level there is a set of behaviors that represent caring, however, the manifestation of these behaviors is 'in the eye of the beholder.' The most important element of caring may not be the set of behaviors but a set of underlying abilities that include taking the patient's perspective and reflecting on the patient's responses.
  
  
  CONCLUSIONS
  Medical education must focus on the underlying abilities of caring.
authors.affiliation: University of Massachusetts Medical School, Worcester, MA 01655, United States. Mark.Quirk@umassmed.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Quirk
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mazor
authors.forename: Heather-Lyn
authors.initials: HL
authors.lastname: Haley
authors.forename: Mary
authors.initials: M
authors.lastname: Philbin
authors.forename: Melissa
authors.initials: M
authors.lastname: Fischer
authors.forename: Kate
authors.initials: K
authors.lastname: Sullivan
authors.forename: David
authors.initials: D
authors.lastname: Hatem
mesh_terms: D000328:Adult; D001294:Attitude to Health; D004645:Empathy; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D019300:Medical Errors; D010166:Palliative Care; D010817:Physician-Patient Relations; D011446:Prospective Studies; D011594:Psychometrics; D015203:Reproducibility of Results; D014342:Truth Disclosure; D014481:United States