Physician burnout and patient-physician communication during primary care encounters

J Gen Intern Med. 2008 Oct;23(10):1581-8. doi: 10.1007/s11606-008-0702-1. Epub 2008 Jul 10.


Background: Although previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies relate physician burnout to observed patient-physician communication behaviors.

Objective: To investigate the relationship between physician burnout and observed patient-physician communication outcomes in patient-physician encounters.

Design: Longitudinal study of enrollment data from a trial of interventions to improve patient adherence to hypertension treatment.

Setting: Fifteen urban community-based clinics in Baltimore, MD.

Participants: Forty 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.

Measurements: Audiotape 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.

Results: The 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.

Conclusions: Physician 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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Attitude of Health Personnel
  • Burnout, Professional / psychology*
  • Cohort Studies
  • Communication*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Physician-Patient Relations*
  • Physicians, Family / psychology*
  • Physicians, Family / trends
  • Primary Health Care / methods*
  • Primary Health Care / trends
  • Randomized Controlled Trials as Topic / trends