• Neda Ratanawongsa, Debra Roter, Mary Catherine Beach, Shivonne L Laird, Susan M Larson, Kathryn A Carson, and Lisa A Cooper.
• Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason Lord Building Center Tower, 5200 Eastern Avenue, Suite 2300, Baltimore, MD 21224, USA. neda@jhmi.edu
• J Gen Intern Med. 2008 Oct 1; 23 (10): 158115881581-8.

BackgroundAlthough previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies relate physician burnout to observed patient-physician communication behaviors.ObjectiveTo investigate the relationship between physician burnout and observed patient-physician communication outcomes in patient-physician encounters.DesignLongitudinal study of enrollment data from a trial of interventions to improve patient adherence to hypertension treatment.SettingFifteen urban community-based clinics in Baltimore, MD.ParticipantsForty physicians and 235 of their adult hypertensive patients, with oversampling of ethnic minorities and poor persons. Fifty-three percent of physicians were women, and the average practice experience was 11.2 years. Among the 235 patients, 66% were women, 60% were African-American, and 90% were insured.MeasurementsAudiotape analysis of communication during outpatient encounters (one per patient) using the Roter Interaction Analysis System and patients' ratings of satisfaction with and trust and confidence in the physician.ResultsThe median time between the physician burnout assessment and the patient encounter was 15.1 months (range 5.6-30). Multivariate analyses revealed no significant differences in physician communication based on physician burnout. However, compared with patients of low-burnout physicians, patients of high-burnout physicians gave twice as many negative rapport-building statements (incident risk ratio 2.06, 95% CI 1.58-2.86, p < 0.001). Physician burnout was not significantly associated with physician or patient affect, patient-centeredness, verbal dominance, or length of the encounter. Physician burnout was also not significantly associated with patients' ratings of their satisfaction, confidence, or trust.ConclusionsPhysician burnout was not associated with physician communication behaviors nor with most measures of patient-centered communication. However, patients engaged in more rapport-building behaviors. These findings suggest a complex relationship between physician burnout and patient-physician communication, which should be investigated and linked to patient outcomes in future research.

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