Clinician Response to Patient Emotion: Impact on Subsequent Communication and Visit Length

Mary Catherine Beach; Jenny Park; Dingfen Han; Christopher Evans; Richard D. Moore; Somnath Saha

doi:10.1370/afm.2740

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Table 1.

Association of Clinician Response With Subsequent Length of Visit

Type of Clinician Response	Subsequent Length of Visit, β (95% CI), Minutes
Type of Clinician Response	Unadjusted Model^{^a}	Model 1^{^b}	Model 2^{^c}
Broad response
Explicit vs nonexplicit	−1.20 (−2.30 to −0.10)	−0.98 (−2.19 to 0.23)	−1.37 (−2.89 to 0.15)
Provides vs reduces space	2.95 (1.55 to 4.35)	1.75 (0.20 to 3.29)	1.27 (−0.63 to 3.18)
Specific response
Provides space
Empathy	1.53 (−0.99 to 4.05)	1.05 (−1.77 to 3.86)	1.38 (−2.26 to 5.01)
Explicit focus on affect	−0.47 (−3.35 to 2.41)	−3.06 (−6.22 to 0.10)	−4.11 (−8.00 to −0.21)
Acknowledgment	−2.02 (−3.38 to −0.65)	−1.17 (−2.69 to 0.34)	−1.14 (−3.06 to 0.78)
Exploring	1.37 (0.06 to 2.68)	1.03 (−0.42 to 2.48)	0.77 (−1.00 to 2.55)
Neutral/passive	1.56 (0.43 to 2.68)	0.76 (−0.47 to 2.00)	0.68 (−0.90 to 2.26)
Reduces space
Gives information/advice	−3.51 (−5.20 to −1.82)	−1.89 (−3.74 to −0.04)	−1.64 (−3.96 to 0.68)
Blocking	−1.75 (−3.98 to 0.48)	−0.62 (−3.06 to 1.82)	−0.03 (−2.85 to 2.79)

Note: Values in bold are statistically significant (P <.05).
↵^aRandom intercept univariate multilevel linear regression models (account for clustering of emotional expressions within patient encounters and of patient encounters within clinicians).
↵^bRandom intercept multilevel linear regression models (account for clustering of emotional expressions within clinicians) with adjustment for the timestamp of the emotional expression.
↵^cRandom intercept multilevel linear regression models (account for clustering of emotional expressions within clinicians) with adjustment for the timestamp of the emotional expression; clinician age, sex, and race/ethnicity; and patient age, sex, and race/ethnicity.

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In Brief

Clinician Response to Patient Emotion: Impact on Subsequent Communication and Visit Length

Mary Catherine Beach and colleagues

Background Beach et al evaluated the association of clinician responses to patient emotions during a clinic visit. Researchers audio-recorded 41 clinicians with 342 unique patients as part of the maRIPOHSA (Maximizing Respect and Improving Patient Outcomes in HIV and Substance Abuse) Study. They classified physicians’ responses to patient emotions as either providing space or reducing space for patients to elaborate on their emotions. Within these categories, they identified these responses as either explicit or non-explicit, meaning that the physician either named the emotion in their response or did not.

What This Study Found They found that patients repeated their emotions when physicians provided space. When physicians explicitly addressed emotions, visit length was shorter. Finally, they noticed that as the clinic visit progressed, the physician was less likely to respond by providing space.

The study took place in an HIV ambulatory care center, where patients received both specialty HIV care and primary care. The mean visit length was 30.4 minutes with 1,028 emotional expressions total. Most clinician responses provided space (81%) and most were non-explicit (56%).

Implications

Beach and her colleagues concluded that if saving time is a goal, clinicians should consider their responses that explicitly address patient emotions.