Consultation length should not be included in communication scales
We read with interest the short news item by Susan Mayor (BMJ, 28 October 2016) and then the article by Elmore et al.(1) about patient satisfaction with GP’s communication and consultation length.
Nowadays, effective Doctor Patient Communication (DPC) is considered as a basic clinical skill (2). It has been shown to lead to improvements in symptom relief, in clinical outcomes and possibly in medication adherence (1). Its assessment has become a major field of clinical research and for this purpose, over the last four decades, a large number of Doctor Patient Communication (DPC) scales have been developed (3).
Among validated scales, some items are systematically included and others are not, without any scientific justification. This is probably the result of the lack of a consensual definition about what DPC is and how it should be measured. As a result rather vague concepts such as satisfaction are used, while some authors consider these should be avoided (4).
The GP Patient Survey (GPPS) used by Elmore is not designed to specifically measure DPC. This survey is widely used in the UK to assess the overall quality of care at a national level and includes communication-specific assessment items among many other criteria (e.g. waiting time). We note that items related to “confidence” and “trust” are not included in the survey although they are often found in many scales aimed at measuring DPC.
Almost all DPC scales include the patient’s perception of time spent during the consultation. Indeed, consultation length perception is a key feature of the GPPS (“the doctor giving you enough time”) and also features in other scales such as the CAT (Communication Assessment Tool)(2) and QQPPI (Questionnaire on the Quality of Physician–Patient Interaction) scale (5). (i.e. “the doctor spent the right amount of time with me”; “spent sufficient time on my consultation”, respectively).
In terms of DPC, even though the doctor may have “spent enough time with the patient”, if he/she didn’t respond to the patient’s communication expectations, the DPC score will not reflect the quality of communication. As Mayor points out, there is no association between consultation length and patient experience of communication (1).
In our opinion, in the future, when assessing communication, we should no longer include items related to the length consultation or/and the perception of time spent in consultation in DPC scales.
Mélanie Sustersic, Alison Foote, Jean-Luc Bosson
(Grenoble, France).
1. Elmore N, Burt J, Abel G, et al. Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care. Br J Gen Pract 2016 ; doi: 10.3399/bjgp16X687733.
2. Makoul G, Krupat E, Chang CH. Measuring patient views of physician communication skills: Development and testing of the Communication Assessment Tool; Patient Education and Counseling.2007; 67:333–342.
3. Zill JM, Christalle E, Müller E, et al. Measurement of Physician-Patient Communication—A Systematic Review. Plos One. 2014. 9(12): e112637. doi:10.1371/ journal.pone.0112637.
4. Bos N, Steve S, Chris Graham. et al. The accident and emergency department questionnaire: a measure for patients’ experiences in the accident and emergency department. BMJ Qual Saf. 2013;22:139–146.
5. Bieber C, Müller KG, Nicolai J, et al. How Does Your Doctor Talk with You? Preliminary Validation of a Brief Patient Self-Report Questionnaire on the Quality of Physician–Patient Interaction . J Clin Psychol Med Settings. 2010; 17:125–136
Competing interests:
No competing interests
02 November 2016
Mélanie Sustersic
Emergency physician,
Alison Foote, Jean-Luc Bosson
University Grenoble Alpes
Equipe ThEMAS - Pavillon Taillefer - CHU 38043 - Grenoble- France
Rapid Response:
Consultation length should not be included in communication scales
We read with interest the short news item by Susan Mayor (BMJ, 28 October 2016) and then the article by Elmore et al.(1) about patient satisfaction with GP’s communication and consultation length.
Nowadays, effective Doctor Patient Communication (DPC) is considered as a basic clinical skill (2). It has been shown to lead to improvements in symptom relief, in clinical outcomes and possibly in medication adherence (1). Its assessment has become a major field of clinical research and for this purpose, over the last four decades, a large number of Doctor Patient Communication (DPC) scales have been developed (3).
Among validated scales, some items are systematically included and others are not, without any scientific justification. This is probably the result of the lack of a consensual definition about what DPC is and how it should be measured. As a result rather vague concepts such as satisfaction are used, while some authors consider these should be avoided (4).
The GP Patient Survey (GPPS) used by Elmore is not designed to specifically measure DPC. This survey is widely used in the UK to assess the overall quality of care at a national level and includes communication-specific assessment items among many other criteria (e.g. waiting time). We note that items related to “confidence” and “trust” are not included in the survey although they are often found in many scales aimed at measuring DPC.
Almost all DPC scales include the patient’s perception of time spent during the consultation. Indeed, consultation length perception is a key feature of the GPPS (“the doctor giving you enough time”) and also features in other scales such as the CAT (Communication Assessment Tool)(2) and QQPPI (Questionnaire on the Quality of Physician–Patient Interaction) scale (5). (i.e. “the doctor spent the right amount of time with me”; “spent sufficient time on my consultation”, respectively).
In terms of DPC, even though the doctor may have “spent enough time with the patient”, if he/she didn’t respond to the patient’s communication expectations, the DPC score will not reflect the quality of communication. As Mayor points out, there is no association between consultation length and patient experience of communication (1).
In our opinion, in the future, when assessing communication, we should no longer include items related to the length consultation or/and the perception of time spent in consultation in DPC scales.
Mélanie Sustersic, Alison Foote, Jean-Luc Bosson
(Grenoble, France).
1. Elmore N, Burt J, Abel G, et al. Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care. Br J Gen Pract 2016 ; doi: 10.3399/bjgp16X687733.
2. Makoul G, Krupat E, Chang CH. Measuring patient views of physician communication skills: Development and testing of the Communication Assessment Tool; Patient Education and Counseling.2007; 67:333–342.
3. Zill JM, Christalle E, Müller E, et al. Measurement of Physician-Patient Communication—A Systematic Review. Plos One. 2014. 9(12): e112637. doi:10.1371/ journal.pone.0112637.
4. Bos N, Steve S, Chris Graham. et al. The accident and emergency department questionnaire: a measure for patients’ experiences in the accident and emergency department. BMJ Qual Saf. 2013;22:139–146.
5. Bieber C, Müller KG, Nicolai J, et al. How Does Your Doctor Talk with You? Preliminary Validation of a Brief Patient Self-Report Questionnaire on the Quality of Physician–Patient Interaction . J Clin Psychol Med Settings. 2010; 17:125–136
Competing interests: No competing interests