Specialist consultations a positive experience for most – but not all – patients

medical education

By Andrew Bracey

28 Oct 2020

Specialist get high marks for listening, showing respect and spending enough time with their patients, although perceptions tend to be less positive for younger people and those with multiple chronic conditions, according to a new report.

Findings from a survey of 28,000 people released by the Australian Institute of Health and Welfare (AIHW) show that 4 out of 5 patients reported that their specialists always listened carefully, showed respect for what they had to say and spent enough time with them.

However, there was a notable decline in the percentage of positive experiences as the number of patients’ chronic conditions increased.

A decrease in satisfaction with specialist interactions was also seen among patients in the younger age bracket (15-39 years), compared to those aged 65 or over, with 77% and 84% respectively reporting that their specialists always listened carefully to them.

Similarly, 77% of younger patients said their specialist spent enough time with them compared to 85% of over 65s, while 81% of younger patients and 86% of those 65 and over reported that their specialist showed respect for what they had to say.

The lowest satisfaction levels were in younger patients with two or more chronic conditions, of whom two thirds (67%) reported that their specialist always listened carefully – compared to 82% of older patients.

Overall, specialists fared slightly better than their GP counterparts. However, the same trends relating to lower satisfaction levels for younger patients and those with multiple chronic conditions was identified across both professional groups.

“Successful patient-centred care approaches are underpinned by good communication: having respectful, two-way conversations and spending adequate time with patients to address their issues and needs,” the report’s authors wrote.

“Improving the health outcomes of people with chronic conditions requires an understanding of their current experiences in the health system and where those experiences could be improved.”

High satisfaction levels

University of WA medical school dean Dr Brendan McQuillan welcomed the high satisfaction ratings reported by the majority of surveyed patients but said ensuring patients fully understood their conditions and treatment options was crucial to achieving the best possible outcomes.

Dr McQuillan, a cardiologist, said the prioritisation of communications training as a core element of modern medical education programs over the past two decades was helping clinicians become better “knowledge brokers” for their patients.

This, he said, would lead to better doctor-patient relationships, patients making more informed decisions, greater adherence to the most appropriate treatment plans and better outcomes.

However, Dr McQuillan said all of this was underpinned by understanding and managing patient expectations. He also suggested that the apparent dissatisfaction with specialists identified among younger patients may occasionally be fuelled by frustration at the absence of quick fix solutions despite their age group often being more likely to better candidates for “aggressive interventions”.

Dr Arvin Damodaran, a rheumatologist and medical educator at the University of NSW, said he believed specialists were generally aware of the issues identified in the study, but it nevertheless highlighted the need to always be on the lookout for ways to further improve patient communication skills.

One such area, he suggested, was managing the transition for younger patients with chronic conditions into the adult health system – a process which could cause “a real rearrangement of expectations”.

“For example, with juvenile idiopathic arthritis … suddenly you may be in an outpatient clinic with longer waits, lots of other people waiting and you get to spend far less time with your specialist for essentially the same condition,” he said.

“And it’s just because you’re a little bit older – so taking people through that transitional period can be difficult.”

Dr Damodaran agreed that modern application and interview processes for medical students, and the focus on building patient rapport during training, was resulting in better selection of future doctors and delivering excellent communicators.

He suggested that a patient’s increasing exposure and experience with health system was a factor in satisfaction levels, and might explain why older patients were likely to have different expectations of their doctors than younger patients.

“This is a pointer to or us to think about what things within education and within the health system that governs those interactions can lead to that dissatisfaction, and [to ask] why do complex patients feel dissatisfied with their patient-doctor interaction or feel that the doctor is not giving them enough time,” he told the limbic.

“What gives me faith though is that the selection of students coming through now, particularly the local students, anecdotally are much better communicators than my colleagues who were selected back in my day without an interview process.”

Dr Damodaran added that while the study provided an interesting view of recent patient experiences, further examination of how patient experiences were trending over time was needed.

[This article has been amended to clarify that Dr Brendan McQuillan is Dean and Head of the Medical School at the University of WA, and a cardiologist, not a rheumatologist as originally stated. We apologise for the error.]

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