A study of patient satisfaction with clinician communication in a tertiary eye care out-patient glaucoma clinic in India

Abstract

Glaucoma is the second leading cause of blindness in the world and is responsible for 12.3% of global blindness (Resnikoff et al., 2004). Patient comprehension of its potential blinding nature is critical to patient understanding of treatment advice and satisfaction with clinician communication. The first phase of this study explored the patient-doctor relationship and mapped the typical points of communication between clinicians and patients in a glaucoma eye clinic in a tertiary eye care centre, using data collected through observations of 51 clinician-patient interactions and in-depth interviews with 28 patients. The findings from this phase highlighted the importance of relational communication in the clinical interaction, indicating patterns of reward and punishment that were labelled ‘Communication Bonuses’ and ‘Communication Disincentives’. The findings suggest that by utilizing communication opportunities during interactions with patients, clinicians could better face the challenges of delivering long-term care to the chronic patient. Listening to the patient's narrative, responding to queries, making eye contact, and showing engagement in the interaction, were identified as some of the ways in which clinicians can responsibly implement communication equity with all their patients. A structured questionnaire of 132 items was piloted among 189 patients to quantify patient's perceptions of clinician communication and reduced to a 95-item questionnaire that was administered to 550 patients. Patient expectations were found to significantly predict patient experience, patient rating of clinician communication style and patient satisfaction with communication. Patient satisfaction was determined by positive content and style of clinician communication. The patient’s positive interaction experience was found to moderate both patient ratings as well as patient satisfaction with clinician communication. Socioeconomic status and level of education were significantly associated with patient expectations, patient experience and patient satisfaction. Further, patient knowledge about glaucoma was significantly related to patient socio-economic status and education level. The study reiterated that patient understanding is a first step toward ensuring patient satisfaction. Formal training in clinician-patient communication is suggested as a way to address established patterns of relational inequities.