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When you’re sick and in need of treatment, it’s likely you want a healthcare provider who is professional, understanding, and knowledgeable. If you’re lucky, you and your provider are also able to relate to each other in an open and respectful manner, and you feel that your problems and needs are understood. In the worst case scenario, you’re treated in an offhand and abrupt manner by someone who only seems interested in moving onto the next patient within as short a time as possible. Finding that perfect healthcare provider may be even more challenging, then, than finding the prefect relationship partner.
Put yourself in the situation of someone admitted to the emergency room following a minor accident. You wait for what seems like an interminable amount of time when someone in hospital garb, who you’ve never met before, comes up to your bed and tries to assess your status. Although you’re obviously not going to be in a very good mood, or even really able to talk, you try to describe your condition as clearly as you can. Within seconds, you decide either (a) this person doesn’t care at all about your problem or (b) this person is truly interested in what you have to say. Given how quickly providers move from patient to patient in the average ER, this is almost like a speed dating situation. However, unlike missed signals with a potential dating partner, the potential costs of a missed communication with a physician can have fatal consequences.
Whether it’s in an ER encounter or over years of treatment, the elements of a good patient-provider relationship are the same. The provider must be able to listen carefully to what you say, balance your description of your symptoms against the many possible diagnoses they represent, and then explain in understandable terms about possible next steps. These basic elements haven’t changed since ancient times, but the methods of putting them into place have altered significantly.
Within recent decades, we’ve seen a shift in the formality of this relationship. The classic physician or nurse’s garb used to follow standard uniform protocols. No one used first names in addressing each other, and patients were just that—“patient.” Given advice by the expert, you would never think to question it and you would obediently and passively abide by what you were told to do. Personal information outside the medical relationship wasn’t exchanged by anyone, unless the “family doctor” was truly treating members of your family.
Now, however, provider-patients relationships are conceived very differently. On popular TV shows, such as “Grey’s Anatomy,” patients argue with their physicians, refuse to comply with advice, and complain loudly when they have to wait. The ante is definitely higher than it used to be, but the changes aren’t all bad. Being given the chance to collaborate with your healthcare provider can allow you to have great buy-in on a treatment plan, increasing the odds that you’ll actually comply with advice, especially when that advice means you’ll have to exercise more, change your dietary habits, and take medications that might be expensive or have unpleasant side effects.
The question, then, is how well does your own healthcare provider measure up to this new model of relationships? Vrije, The Netherlands, University Medical Department’s Christina M. Van der Feltz-Cornelius and her colleagues (2004) developed a 9-item Patient-Doctor Relationship Questionnaire (PDRQ-9) to be used in general practice. Wayne State University’s John H. Porcerelli and colleagues (2014) more recently validated the PDRQ-9 against similar measures but also added a measure of how “difficult” the physician perceived the patient to be (the Difficult Doctor-Patient Relationship Questionnaire or DDRPQ). Pitting the two perceptions against each other, Porcerelli reasoned, would help partition out the extent to which the patient, vs. the physician, contribute to a healthcare relationship gone sour.
In the Porcerelli study, the two relationship measures were, as expected, negatively related. In addition, the PDRQ-9 turned out to have validity in English similar to that in the original Dutch validation study. Moreover, the PDRQ-9 proved to be insensitive to other factors about a patient (such as age, self-reported overall health, psychological distress, and health as reported by the physician). We can feel reasonably confident, then, that the PDRQ-9 is a short and simple way to test the amount of trust people feel toward their health professionals.
With this background, here are the 9 items on the PDRQ. Rate each for your “PCP” (primary care provider”) on a 1-5 point scale, with 1 representing lack of agreement and 5 representing total agreement. Then we’ll see what your scores mean:
- My PCP helps me
- My PCP has enough time for me
- I trust my PCP
- My PCP understands me
- My PCP is dedicated to help me
- My PCP and I agree on the nature of my medical symptoms
- I can talk to my PCP
- I feel content with my PCP’s treatment
- I find my PCP easily accessible
We’ll compare your scores now to those of the U.S. sample, which consisted of 123 women and 57 men averaging 38 years old being seen in a suburban university-based primary care clinic. Men and women actually scored very similarly, so we don’t need to factor gender into account when interpreting what your scores might mean. The average among the sample was right about 40. With 45 as the highest possible score and 9 as the lowest, it was clear that most participants felt pretty good about their PCP’s. The range was actually 10 to 45; therefore, if your score was anywhere below 35, it means that you and your PCP are not particularly well-matched.
For their part, PCP’s were pretty accepting of their patients. The total scores on the DPRPQ could range between 10 and 58, but the average score was about 20. Interestingly, the poorer the patient’s health, as rated both by the patient and the PCP, the higher the rating of the patient’s tendency to have negative personality characteristics, such as manipulativeness, that could make the medical encounter more challenging interpersonally, as the authors conclude.
As in all relationships, patient-provider communication is a two-way street. The more straightforward you are with your provider, the more positively you’ll be regarded, and the more, in turn, you’ll get out of the relationship. In the long run, your health, and your fulfillment, will benefit.
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Copyright Susan Krauss Whitbourne 2015
References:
Hahn, S. R. (2000). The Difficult Doctor Patient Relationship Questionnaire. In M. E. Maruish, M. E. Maruish (Eds.) , Handbook of psychological assessment in primary care settings (pp. 653-683). Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers.
Porcerelli, J. H., Murdoch, W., Morris, P., & Fowler, S. (2014). The Patient–Doctor Relationship Questionnaire (PDRQ-9) in primary care: A validity study. Journal of Clinical Psychology In Medical Settings, 21(3), 291-296. doi:10.1007/s10880-014-9407-2
Van der Feltz-Cornelis, C. M., Van Oppen, P., Van Marwijk, H. W. J., De Beurs, E., & Van Dyck, R. (2004). A patient–doctor relationship questionnaire (PDRQ-9) in primary care: Development and psychometric evaluation. General Hospital Psychiatry, 26, 115-120.
