How stressful is doctor-patient communication? Physiological and psychological stress of medical students in simulated history taking and bad-news consultations.
BACKGROUND
Medical communication can be a stressful experience for both doctors and patients. In particular, inexperienced doctors facing the demanding task of a bad news consultation may experience high levels of distress. The aim of this exploratory study is to test students' differential cardiovascular reactivity to history taking and bad news consultations with a simulated patient, and to test the relation between the students' self-reported stressfulness of the consultation and their cardiovascular response.


METHODS
Fourth and fifth year medical students (n=20) conducted a history taking (HT) and a bad news (BN) consultation in a randomized order with a standardized patient. Heart rate (HR), mean arterial pressure (MAP), cardiac output (CO) and systemic vascular resistance (SVR) were assessed by way of the Finapres-technique in four conditions: rest, reading aloud, and during both consultations. Self-reported stress was assessed before and after each interview using the State and Trait Anxiety Inventory (STAI), and a visual analogue scale (VAS).


RESULTS
Both HT and BN provoked more cardiovascular stress than reading. Bad-news provoked the highest HR and CO responses compared to all other conditions, and had a greater impact when it was the student's first consultation. The STAI and VAS data showed some correlations with the cardiovascular stress measures and a comparable but less significant pattern in stress response.


CONCLUSIONS
The effect of order of the HT and BN consultations on the students' stress levels suggests an additional impact of novelty and habituation. Unfamiliarity with the patient may enhance the stressfulness of the task of breaking bad news.
Hulsman
Robert L
RL
Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands. R.L.Hulsman@amc.uva.nl
Pranger
Susan
S
Koot
Stephanie
S
Fabriek
Marcel
M
Karemaker
John M
JM
Smets
Ellen M A
EM
D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D002983:Clinical Competence; D003142:Communication; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D016544:Patient Simulation; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D013315:Stress, Psychological / Q000503:physiopathology / Q000523:psychology; D013337:Students, Medical / Q000523:psychology*; D014342:Truth Disclosure; D055815:Young Adult