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| Year : 2014 | Volume
: 60
| Issue : 2 | Page : 220-221 |
Authors' reply
M Baidya, V Gopichandran
School of Public Health, Medical College, Sri Ramaswamy Memorial University, Kattankulathur, Tamil Nadu, India
| Date of Web Publication | 13-May-2014 |
Correspondence Address:
M Baidya
School of Public Health, Medical College, Sri Ramaswamy Memorial University, Kattankulathur, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Baidya M, Gopichandran V. Authors' reply. J Postgrad Med 2014;60:220-1 |
Sir,
Walsh K has rightly pointed out that concentrating on the amount of time spent with physician could enhance patient's satisfaction. [1] The alternatives suggested by Walsh do have in common focusing on consultation time. The two alternatives address both quality and quantity of consultation time. It is important to understand that the study setting where the referred assessment was done. It is a health care set up in a developing country without universal access to health care. There are certain unique features of trust and satisfaction in these settings. For example, personal involvement with the physician; shared identity, such as religion, language caste, and behavioral factors, such as kindness, compassion, and eliciting a sense of comfort among others are important factors identified with promoting trust in these settings in a previous assessment by the same research team. [2]
Previous studies have shown that increasing the duration of consultation has resulted in better patient satisfaction. [3] In this study, the authors recommended that chatting about a few nonmedical topics might significantly increase the perception of greater time of consultation. We found that in our study setting, the same was articulated as "personal involvement of the physician" in which the physician enquires about family, personal issues , and other nonmedical topics.
The first alternative proposed by Walsh K is a hard bargain, not because of the ability to achieve it, but because the topic is about satisfaction with the physician and not the health care system as a whole. In health care settings such as ours, satisfaction with the physician plays a very important role. Substituting time spent with the physician with time spent with an allied health professional may increase overall health care satisfaction but is unlikely to increase satisfaction in the physician. One may ask how this matters. Previous studies have shown that trust in physicians and satisfaction in physicians is an important determinant of clinical outcomes independent of satisfaction with the health system.
The second alternative is very important as it directly impinges on the behavioral aspects of the physicians, which were identified in a previous qualitative study of trust in physicians in the same setting. [4] It may significantly improve the way the time spent by the physician is perceived by the patient and thus improve trust as well as satisfaction.
Having said the above, it is important to note that whatever the interventions may be, there has been very little evidence to show that trust can actually be improved or changed. All these interventions have to happen in a background of ethical practices. The intention should be in the patients' best interest and there can be no alternative to that. Any behavioral or time-related manipulations may be seen directly through when the intentions do not match them. [5] Growing health care systems and modern medical technologies can shed new light on patient-physician relationship while producing new threats for patient-physician trust relationship. Thus changing the nature of counseling alone may not be sufficient for enhanced patient satisfaction. It needs to be backed up by organizational climate and behavior, where there should be a common understanding that: It is not how much time does a physician spends with a patient, but s how the physician spends his/her time with the patients.
| :: References | |  |
| 1. | Walsh K. Patient trust and satisfaction: Ways to make a difference. J Postgrad Med 2014;60:220. 
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| 2. | Gopichandran V, Chetlapalli SK. Factors influencing trust in doctors: A community segmentation strategy for quality improvement in healthcare. BMJ Open 2013;3:e004115.
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| 3. | Gross DA, Zyzanski SJ, Borawski EA, Cebul RD, Stange KC. Patient satisfaction with time spent with their physician. J Fam Pract 1998;47:133-7.
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| 4. | Gopichandran V, Chetlapalli SK. Dimensions and determinants of trust in health care in resource poor settings: A qualitative exploration. PloS One 2013;8:e69170.
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| 5. | Rolfe A, Cash-Gibson L, Car J, Sheikh A, McKinstry B. Interventions for improving patients' trust in doctors and groups of doctors. Cochrane Database Syst Rev 2014;3:CD004134.
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