title: General Practitioners' Empathy and Health Outcomes: A Prospective Observational Study of Consultations in Areas of High and Low Deprivation.
abstract: OBJECTIVE
  We set out to compare patients' expectations, consultation characteristics, and outcomes in areas of high and low socioeconomic deprivation, and to examine whether the same factors predict better outcomes in both settings.
  
  
  METHODS
  Six hundred fifty-nine patients attending 47 general practitioners in high- and low-deprivation areas of Scotland participated. We assessed patients' expectations of involvement in decision making immediately before the consultation and patients' perceptions of their general practitioners' empathy immediately after. Consultations were video recorded and analyzed for verbal and non-verbal physician behaviors. Symptom severity and related well-being were measured at baseline and 1 month post-consultation. Consultation factors predicting better outcomes at 1 month were identified using backward selection methods.
  
  
  RESULTS
  Patients in deprived areas had less desire for shared decision-making (P <.001). They had more problems to discuss (P = .01) within the same consultation time. Patients in deprived areas perceived their general practitioners (GPs) as less empathic (P = .02), and the physicians displayed verbal and nonverbal behaviors that were less patient centered. Outcomes were worse at 1 month in deprived than in affluent groups (70% response rate; P <.001). Perceived physician empathy predicted better outcomes in both groups.
  
  
  CONCLUSIONS
  Patients' expectations, GPs' behaviors within the consultation, and health outcomes differ substantially between high- and low-deprivation areas. In both settings, patients' perceptions of the physicians' empathy predict health outcomes. These findings are discussed in the context of inequalities and the "inverse care law."
authors.affiliation: Academic Unit of General Practice and Primary Care, Institute of Health and Well-Being, University of Glasgow, Glasgow, Scotland Stewart.Mercer@glasgow.ac.uk.
authors.forename: Stewart W
authors.initials: SW
authors.lastname: Mercer
authors.affiliation: Academic Unit of General Practice and Primary Care, Institute of Health and Well-Being, University of Glasgow, Glasgow, Scotland.
authors.forename: Maria
authors.initials: M
authors.lastname: Higgins
authors.affiliation: Academic Unit of General Practice and Primary Care, Institute of Health and Well-Being, University of Glasgow, Glasgow, Scotland.
authors.forename: Annemieke M
authors.initials: AM
authors.lastname: Bikker
authors.affiliation: Academic Unit of General Practice and Primary Care, Institute of Health and Well-Being, University of Glasgow, Glasgow, Scotland.
authors.forename: Bridie
authors.initials: B
authors.lastname: Fitzpatrick
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland.
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Lloyd
authors.affiliation: Primary Medical Care, Aldermoor Health Centre, University of Southampton, Southampton, England.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Academic Unit of General Practice and Primary Care, Institute of Health and Well-Being, University of Glasgow, Glasgow, Scotland.
authors.forename: Graham C M
authors.initials: GC
authors.lastname: Watt
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D004645:Empathy; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012017:Referral and Consultation; D012606:Scotland; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014741:Video Recording
keywords: outcome and process assessment; physician empathy; primary health care; socioeconomic status