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Patient-Centered Communication During Primary Care Visits for Depressive Symptoms: What is the Role of Physician Personality?

Chapman, Benjamin P. PhD*; Duberstein, Paul R. PhD*; Epstein, Ronald M. MD†; Fiscella, Kevin MD, MPH†; Kravitz, Richard L. MD, MSPH‡

Medical Care:
doi: 10.1097/MLR.0b013e31817924e4
Original Article
Abstract

Background: Patient-centered communication (PCC) is associated with more appropriate treatment of depression in primary care. Aside from patient presentation, little is known about other influences on PCC. We investigated whether PCC is influenced by personality dispositions of primary care providers, independent of patient presentation.

Methods: Forty-six primary care providers completed personality scales from the NEO-Personality Inventory, revised and provided care to 88 standardized patients presenting with either major depression or adjustment disorder with comorbid musculoskeletal symptoms, either making or not making a medication request. Coders scored each visit using the measure of PCC, assessing physicians’ ability to explore the patient's illness experience (component 1), understand the patient's psychosocial context (component 2), and involve the patient in collaborative discussions of treatment (component 3).

Results: Adjusting for physician demographics, training, and patient presentation, physicians who were more open to feelings explored the patient's experience of illness more (P = 0.05). More dutiful, or rule-bound physicians engaged in greater exploration of the patient's psychosocial and life circumstances (P = 0.04), but involved the patient less in treatment discussions (P = 0.03). Physicians reporting more anxious vulnerability also involved the patient less (P = 0.03). Physician demographics, training, and patient presentation explained 4–7% of variance in the measure of patient-centered communication components, with personality explaining an additional 4–7% of the variance.

Conclusions: Understanding of personality dispositions that promote or detract from PCC may help medical educators better identify trainees of varying aptitude, facilitate medical career counseling, and address individual training needs in a tailored fashion.

Author Information

From the Departments of *Psychiatry and †Family Medicine Research, University of Rochester Medical Center, Rochester, New York; and the ‡Department of Internal Medicine, Center for Health Services Research in Primary Care, University of California, Davis Medical Center, Sacramento, California.

Supported by grants 5 R01 MH 064683-03 (to R.L.K.), Principal Investigator; T32 MH073452 (to Jeffrey M. Lyness and P.R.D.); K24 MH 72756 MH072712 (to P.R.D.); and K24MH072756 (to R.L.K.).

Reprints: Benjamin P. Chapman, PhD, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden, Rochester, NY 14642. E-mail: ben_chapman@urmc.rochester.edu.

© 2008 Lippincott Williams & Wilkins, Inc.