How patients perceive a doctor\u27s caring attitude

OBJECTIVE: Caring is closely associated with reduced malpractice litigation, adherence to treatment and even symptom relief. Caring also is included in pay for performance formulas as well as widely utilized for quality improvement purposes. Our objective in this prospective qualitative study was to define caring behaviors associated with three challenging encounters: discussing the transition from curative to palliative care, delivering bad news (cancer), and discussing a medical error (misplaced test result). The purpose was to lay the groundwork for the creation of a \u27patient-centered\u27 caring attitude checklist that could help the healthcare provider understand and ultimately enhance the patient\u27s experience of care. METHODS: Groups of randomly selected lay people, henceforth referred to as patients: (1) engaged in \u27think aloud\u27 exercises to help create a 15-item caring behavior checklist; (2) used the checklist to rate videotapes of simulated challenging encounters conducted by twenty primary care physicians (total of 600 ratings sets); and (3) participated in 12 separate 1.5 h focus groups discussing the caring (and non-caring) behaviors exhibited in videotapes of the highest and lowest rated encounters. RESULTS: Thirteen behaviors emerged as focal for describing a doctor\u27s caring attitude but with disagreement as to whether specific examples of these behaviors were \u27caring\u27 or \u27uncaring.\u27 For example, although the concept of empathic inquiry was considered important by most patients, the physician question, Is there someone you can call or talk with (about a cancer diagnosis) was interpreted by one patient as \u27very caring\u27 while another was \u27impressed with how uncaring\u27 the statement appeared. CONCLUSION: At the conceptual level there is a set of behaviors that represent caring, however, the manifestation of these behaviors is \u27in the eye of the beholder.\u27 The most important element of caring may not be the set of behaviors but a set of underlying abilities that include taking the patient\u27s perspective and reflecting on the patient\u27s responses. PRACTICE IMPLICATIONS: Medical education must focus on the underlying abilities of caring