Research ArticleMethodology

Ratings of Physician Communication by Real and Standardized Patients

Kevin Fiscella, Peter Franks, Malathi Srinivasan, Richard L. Kravitz and Ronald Epstein
The Annals of Family Medicine March 2007, 5 (2) 151-158; DOI: https://doi.org/10.1370/afm.643

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Relationship between adjusted standardized patient and real patient ratings of physicians.

    BLUP = best linear unbiased prediction; SP = standardized patient; HCCQ = Health Care Climate Questionnaire.

Tables

  • Table 1.

    Characteristics of Physicians in Sample (N = 100)

    Characteristic% With CharacteristicCharacteristic% With Characteristic
    Note: results are unadjusted.
    SexSolo practitioner
        Female23Yes24
        Male77No76
    Family physicianRural practice
        Yes47Yes32
        No53No68
  • Table 2.

    Characteristics of Real Patients in the Sample

    CharacteristicValue
    *Numbers differ slightly due to missing value.
    MCS-12 = medical component summary of the SF-12 Health Survey; PCS-12 = physical component summary of the SF-12 Health Survey; HCCQ = Health Care Climate Questionnaire.
    Total, No. (%)4,746 (100)
    Age, years, mean (SD)44.9 (12.1)
    Sex, No. (%)
        Female2,955 (62.3)
        Male1,750 (36.9)
    Race, No. (%)
        African American499 (10.5)
        Hispanic109 (2.3)
        Other110 (2.3)
        White3,994 (84.2)
    Education, No. (%)
        <12 years337 (7.1)
        12th grade1,370 (28.9)
        1–3 years college1,470 (31.2)
        4 years college828 (17.4)
        Graduate school700 (14.7)
    Length of patient-doctor relationship, No. (%)
        <1 years360 (7.6)
        1–3 years1,035 (21.8)
        3–5 years814 (17.2)
        >5 years2,525 (53.2)
    Number of medical conditions, mean (SD)2.3 (1.5)
        MCS-1248.8 (10.5)
        PCS-1246.0 (11.1)
        HCCQ8.0 (3.1)
  • Table 3.

    Correlations Among the Physician-Level Mean HCCQ and PPPC Scores Obtained From Real Patients and Standardized Patients

    MeasureReal Patient HCCQ (Previsit)Real Patient PPPC (Postvisit)SP HCCQ (Postvisit)
    HCCQ = Health Care Climate Questionnaire; PPPC = Patient Perception of Patient Centeredness questionnaire; SP = standardized patient.
    Real patient PPPC (postvisit)0.74––
    SP HCCQ (postvisit)0.330.32–
    SP PPPC (postvisit)0.330.260.89

Additional Files

  • The Article in Brief

    Ratings of Physician Communication by Real and Standardized Patients

    Kevin Fiscella, MD, MPH, and colleagues

    Background This study examines the strengths and limitations of two methods of rating doctors� communication skills. The two methods are ratings by real patients and ratings by standardized patients (people who are trained to portray specific patient cases in predetermined ways).

    What This Study Found Trained standardized patients, who visit a doctor unannounced, provide a more objective (though much narrower) assessment of doctors� communication skills than do real patients. Ratings of doctors� communication by standardized patients have better psychometric (statistical and psychological) properties than ratings by real patients. Ratings by real patients and standardized patients provide different information.

    Implications

    • Real and standardized patients rate doctors� communication styles differently.
    • Differences in ratings by standardized and real patients may be due to differences in their relationship with the doctor (that is, an ongoing relationship for the real patient vs a one-time visit fo
    • Both standardized and real patients provide useful information for understanding the clinician-patient relationship.
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