Can patient surveys identify poor quality GP-patient communication?

Good GP-patient communication is a good thing, right? I think we can all agree that, when we are patients, it’s good to feel like we have been listened to, given the opportunity to make decisions about care, and finish a consultation with a sense of understanding about what’s just happened and what’s going to happen. Governments value good GP-patient communication, too, and it has been creeping into evaluations of the quality of health care around the world (sometimes with payment attached, sometimes not). Such high-level assessment means we need big enterprises like the GP Patient Survey to enable patients to tell us what they think about the GPs they have been seeing, and how well they communicated with them. We generally expect these surveys to highlight when a GP practice is doing well, and when they are not doing so well. But do they?

Our latest patient experience research suggests that perhaps patient surveys may not in fact be so good at identifying poor quality GP-patient communication. We looked at the evaluations patients gave of a GPs’ communication skills immediately after their consultation with them, and compared these to the evaluations given by trained clinical raters watching a video of the same consultation. We were particularly interested in seeing if patient assessments would match accepted professional standards of communication: that is, is a patient’s ‘good enough’ the same as a clinical peer judges to be ‘good enough’? Our analyses suggested that there was indeed an association between patient ratings of communication and professionally-defined standards of care. When trained clinical raters identified communication as good, patients tended to agree with this. However, when trained clinical raters identified communication as poor, patients ranged in their assessments of communication from poor to very good. That is, poor from a clinical rater’s perspective was not always picked up as poor from a patient’s perspective. One possible explanation for this (there’s more discussed in our paper) is that some patients are inhibited in criticising a doctor’s performance, finding it difficult to report poor quality care on a questionnaire. We’re doing further qualitative work to investigate this, so watch this space. However, our current findings clearly point to the possibility that mean patient survey scores may overestimate adherence to best doctor-patient communication practices. Crucially, therefore, we cannot necessarily assume that an apparently high mean patient rating suggests all is well for communication within a practice, and the take-home message is that higher scores should not breed complacency.

For full details of the study, see:

Burt J, Abel G, Elmore N, Newbould J, Davey A, Llanwarne N, Maramba I, Paddison C, Benson J, Silverman J, Elliott MN, Campbell J, Roland M. Rating communication in GP consultations: the association between ratings made by patients and trained clinical raters. Medical Care Research and Review 2016

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  • The Cambridge Centre for Health Services Research (CCHSR) is a thriving collaboration between the University of Cambridge and RAND Europe. We aim to inform health policy and practice by conducting research and evaluation studies of organisation and delivery of healthcare, including safety, effectiveness, efficiency and patient experience.