Medical information delivered to patients: Discrepancies concerning roles as perceived by physicians and nurses set against patient satisfaction

Abstract

Objective

To assess and to compare roles as perceived by physicians and nurses regarding medical information delivered to patients and to set this against patients’ opinions on the quality of the medical information delivered to them.

Methods

A questionnaire administered to 302 physicians (MDs) and 533 nurses (NUs), and an inpatient satisfaction survey administered to 1246 patients the day before discharge, as a part of a quality improvement program on patient information in a university hospital.

Results

MDs and NUs reported that diagnosis and prognosis announcements were made by MDs alone. Concerning explanations about diagnosis, information on investigations, and benefits and risks of treatment, NUs considered that they provided information in addition to MDs, while MDs considered that it was generally they alone who delivered the information. Patients were generally very satisfied with information delivered, but more than 20% were not satisfied with information on benefits and risks of investigations and treatments. The most important problem underlined by NUs was that they lacked knowledge of the medical information delivered to patients by MDs (55%).

Conclusion

Perceived roles in the transmission of medical information to patients were very different between MDs and NUs. Patient satisfaction seemed to be greater where professional roles were clear-cut. Physicians did not recognise the primary role of the NUs. Lack of MD–NU collaboration affects the quality of patient care.

Practice implications

A better definition of the specific roles of MDs and NUs, their training in effective methods of asserting opinions and knowledge and in conducting collaborative ward rounds would be of benefit to patients.

Introduction

With the progress of medical science in the last 50 years, the patient–physician relationship has fundamentally altered. The traditional asymmetric relationship of physician to patient, the previously dominant “paternalistic model”, has shifted towards an empowerment of the patient who has become a player in his or her health and healthcare. As a result, information provided to patients has become a central part of care provision. Patients can make the right decisions about treatment only if they are informed about any side effects, possible complications, and the way treatment might affect their daily life. The quality of the communication relationship between physician and patient has thus become essential, and in particular the primary role of the physician in providing information [1], [2], [3]. The quality of the information delivered to the patient can be assessed in particular from the way in which wordings are suited to understanding, and from the clarity of explanations on diagnosis, on complementary investigations required, and on treatment recommended [4], [5], [6]. In France, these changes in the patient–physician relationship have taken the concrete form of a law passed on 4 March 2002 on patient rights and the improvement of the healthcare system, which instates the right to information as a fundamental patient right [7]. However several studies have shown differences in perception between health professionals and patients regarding the quality of medical information delivered [8], [9], [10], [11], [12]. Indeed some studies have suggested that healthcare workers have limited awareness of patients’ opinions regarding the provision and receipt of health-related information [8], [13].

In hospital, interaction does not involve solely the physician and his/her patient; it also involves a complex chain of diagnosis and medical care, which in general implicates several physicians as well as paramedical professionals, who may or may not be working in a structured team. This wide involvement of different individuals does however require good communication among these different individuals, and coordination of the different actions undertaken, so as to avoid unneeded repetition, inconsistency, or misinformation in dealings with the patient.

Several studies have suggested that quality of care can be gained by collaborative practice between physicians and nurses [14], [15], [16]. In addition to this, good cooperation between nurses and physicians is a characteristic of the “magnet hospitals”, which have lower nurse turnover and greater job satisfaction [17], [18]. The collaboration between physicians and nursing staff has been widely studied, in particular in intensive care units [15], [19], [20]. This work has generally shown that there are divergences between the expectations of the two in this respect: nurses are more likely to give a poor rating of actual collaboration with the physician than they are to consider it to be good [21], [22]. However few studies have explored perceived differences between physicians and nurses with respect to their roles in the delivery of information to patients [22], [23], and to our knowledge no research work has set out to compare role conception on the part of professionals in this respect with the satisfaction of patients with the information they receive.

In order to study whether the quality of physician–nurse interaction in delivery of medical information to the patient improves patient satisfaction, the present work therefore aimed to compare the perceived roles and practices of physicians and nurses in delivering information to inpatients, and to compare these perceptions with patient opinions on the quality of the medical information delivered.