Are Patients’ Ratings of Their Physicians Related to Health Outcomes?

In their paper, “Are patient ratings of their physicians related to health outcomes?” Franks et al used random effects linear regression to examine the contribution of individual physician effects and patients’ perceptions of their physicians to patient-reported decline in health status over the past 12 months.1 The authors found “..no evidence of a physician effect on reported health status decline” and concluded that the association between patient perception of the physician and reported health status decline “…may reflect unmeasured patient confounding.” While I agree with the authors that patient characteristics should be considered when interpreting associations between patient perceptions of the physician and patient-reported outcomes, I think it is important to emphasize that their results do not exclude physician behaviors specific to the patient, as an explanation for the association between patient perceptions of the physician and patient-reported health decline. For example, some physicians may be less supportive toward some patients (who would then report feeling less supported), even if physicians are approximately equally supportive to their patients on average. In this case, there would be no ‘physician effect’ as defined by the authors, yet the physicians' behaviors could still be a cause of the patients' reported decline in health status.

Observed physician behaviors during an office visit have been associated with subsequent patient satisfaction, understanding and compliance,2 though not, to my knowledge, with a global health outcome such as was used in the current study. The current study highlights the need to investigate observed physician behaviors as well as physician characteristics in understanding the association of patient reports of physician behaviors and the quality of the patient-physician relationship with both specific and short-term as well as global and long-term health- related outcomes.

1. Franks P, Fiscella K, Shields CG, Meldrum SC, Duberstein P, Jerant AF, Tancredi DJ, Epstein RM. Are patient ratings of their physicians related to health outcomes? Ann Fam Med 2005;3:229-234.

2. Beck RS, Daughtridge, Sloane PD. Physician-patient communication in the primary office: a systematic review. J Am Board Fam Pract 2002;15:25-38.

Competing interests:   None declared