UC Riverside

The objective of this dissertation study was to develop a reliable and valid scale, called the Physician Patient Behavioral Characteristics Scale (PPBCS), to assess physician and patient behavioral characteristics that are expressed during the primary care medical visit. Relationships were assessed between PPBCS composite ratings, physician characteristics, visit satisfaction as expressed by both patients and physicians, and rated global affect in audio recordings of the medical visit. The degree to which physician gender and ethnicity was related to physician satisfaction was also examined across levels of patient income/socioeconomic status (SES). Four judges used the PPBCS to objectively rate 298 physician-patient audio recordings from a study originally fielded by the Bayer Institute for Health Care Communication. The PPBCS was shown to have good interrater reliability. Principal components analyses yielded two physician factors, enthusiasm and frustration, and three patient factors, demanding, enjoyable, and nonadherent. Scale composites formed from these factors had good internal consistency. The PPBCS demonstrated empirical validity in correlations of physician and patient factors with patient satisfaction. As expected, physicians who were rated highly on enthusiasm had patients’ who perceived better opportunities for decision-making, better choice in their care, and had more positive perceptions of their physicians’ ability to provide information. Further evidence of validity was revealed from correlations: Enjoyable patients and enthusiastic physicians (as rated on the PPBCS) perceived there to be more effective communication, more patient involvement, and more healthy collaboration in the medical interaction. The PPBCS was also shown to have good convergent validity due to correlations with the zBGRS, another observer-rated measure of patient and physician behavioral characteristics in the medical visit. In general, there were few significant relationships between physician characteristics and PPBCS composites, PSQ, and zBGRS measures. Physicians’ reported level of stress, however, was negatively correlated with assessments of their satisfaction with: the medical visits, the use of time, and with the patient. Analysis of the relationships between physician gender and patient and physician behavioral characteristics revealed female physicians to be more enthusiastic compared to male physicians. Female physicians were also found to be more effective communicators and more engaged in healthy collaboration compared to male physicians. There were no relationships between physicians’ gender-ethnicity group membership and physicians’ satisfaction with patients of different SES, however. Strengths, limitations, and clinical implications of this study were also discussed.