Perceptions of physician behavior : the effect of physician expressive and technical competence on psychological symptom disclosure PDF
Preview Perceptions of physician behavior : the effect of physician expressive and technical competence on psychological symptom disclosure
PERCEPTIONS OF PHYSICIAN BEHAVIOR: THE EFFECT OF PHYSICIAN EXPRESSIVE AND TECHNICAL COMPETENCE ON PSYCHOLOGICAL SYMPTOM DISCLOSURE By MIGUEL A. FRANCO A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 1991 ACKNOWLEDGEMENT There are many people I wish to thank for their assistance, guidance, and friendship while I have been in the counseling psychology program at the University of Florida. Shae Kosch could not have been a better supervisor. Not only was Shae supportive during difficult times, she was the one who introduced me to the "real" world of psychotherapy. Shae s patience and attention to detail ' are what I am most grateful for. Harry Grater is another person who played a major role in my professional development. Harry's abilities to teach, and stimulate me to listen to my inner voice in therapy are what I am most grateful for. I want to thank the Minority Fellowship Program for making it financially possible for me to make it through graduate school at the University of Florida. Special thanks go to Linda Hellmich. I am happy that we are in the same field. Internship year played a critical role in my overall development. When I was accepted as an intern at Notre Dame/Oaklawn I had very high expectations. Rita Donley almost single handedly surpassed all of these expectations. 11 I want to thank my mother, Myriam, and my father, Antonio "Chuchito" Franco. I could not have done it without their support. I want to thank my big brother, Tony. Every kid needs a "big" brother. I am grateful that I have him as mine. I want to thank the rest of my family, Luly, Tio, Abuela Kela, Abuelo Tin, Abuela Angelina and the boss, Antonio "Chucho" Franco Tauler. I want to thank my children, Candice and Daniel, for bearing with me, and inspiring me. They are proof that God works overtime. Finally, I want to thank the most important person in my life, my wife B.J. I dedicate this work to her. Ill TABLE OF CONTENTS PAGE ACKNOWLEDGEMENTS ii LIST OF FIGURES vi LIST OF TABLES vii ABSTRACT vii CHAPTERS 1. INTRODUCTION 1 2. REVIEW OF THE LITERATURE 6 .... Psychological Disorders in Primary Care 6 Cost Benefit Analysis of Treating Psychological Concerns 8 Research on Physician-Patient Communication 11 . . Therapist-Client Relationship and its Salience to the Physician-Patient Relationship 16 ... Psychological Research on Self-disclosure 21 Attributes of the Recipient of Self-disclosure 22 .... Characteristics of the Disclosing Person 26 Properties of the Disclosure Situation 28 Topic or Content of Self-disclosure 33 Purpose of the Study 34 3. METHODS 43 The Videotaped Medical Interviews 45 Operational Definitions 46 Subjects 47 Procedure 47 Variables 48 Dependent Variables 53 Hypothesis Testing 56 IV 4. RESULTS 59 Pretest of the Expressive & Technical Competence Manipulation 59 Demographics 61 Hypothesis 1 61 Hypothesis 2 67 Hypothesis 3 70 Hypothesis 4 71 General, Private, and Psychological Symptom Disclosure 71 Correlational Analysis 75 5. DISCUSSION 78 Analysis of Hypotheses One and Four (ANOVA I) 79 . Analysis of Hypothesis Two (ANOVA II) 89 Analysis of Hypothesis Three 91 Concluding Remarks 94 APPENDICES A. SCRIPTS OF EXPRESSIVE SKILL/TECHNICAL SKILL MANIPULATIONS 102 B. CONSENT FORM 112 C. SYMPTOMS QUESTIONNAIRE 113 D. SMITH-FALVO PATIENT-DOCTOR INTERACTION SCALE 116 . . E. PRE TEST QUESTIONNAIRE 117 F. PRE TEST ANOVA SUMMARY TABLES 118 REFERENCES 121 BIOGRAPHICAL SKETCH 134 LIST OF FIGURES Figure Page 4.1 ANOVA I Expressive Dimension Manipulation: Physician Gender x Subject Gender Interaction 65 4.2 ANOVA I Expressive Dimension Manipulation: Physician Gender x Level of Expressive Skill Interaction 66 4.3 ANOVA II Technical Dimension Manipulation: Physician Gender x Subject Gender Interaction 69 4.4 ANOVA IV High Expressive Dimension Condition: Degree of Psychological Disclosure to Male vs. Female Physician 73 VI 1 LIST OF TABLES Tables Page 4 Population of Study 62 . 4.2 Hypothesis One: Expressive Skill Manipulation Summary Table 63 4.3 Hypothesis One: Expressive Skill Manipulation Test for Interaction Summary Table 63 4.4 Hypothesis Two: Technical Skill Manipulation Summary Table 68 4.5 Hypothesis Two: Technical Skill Manipulation Test for Interaction Summary Table 68 4.6 Hypothesis Four: Summary Table of High Expressive Condition When Disclosing Psychological Symptoms to a Male Versus Female Physician 72 4.7 Hypoithesis Four: Summary Table of Test of Interaction Between Subject and Physician Gender When Disclosing Psychological .... Symptoms to a High Expressive Physician 74 4.8 Correlations Between Degree of Psychological Symptom Disclosure and Degree of Importance of Physician Behaviors 76 vii Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy PERCEPTIONS OF PHYSICIAN BEHAVIOR: THE EFFECT OF PHYSICIAN EXPRESSIVE AND TECHNICAL COMPETENCE ON PSYCHOLOGICAL SYMPTOM DISCLOSURE By MIGUEL A. FRANCO Chairman: Franz Epting, Ph.D. Major Department: Psychology Physician underdiagnosis of psychological symptoms is well documented. This study investigates whether perceptions of specific physician behaviors exert an effect on willingness to disclose psychological symptoms. Forty male and forty female subjects, imagining a future visit of their own to two physicians viewed on videotape, rated their willingness to disclose symptoms of a general, private, and psychological nature to the male or the female physician. The trigger videotapes were of a male and female physician, in their mid-thirties, white, and physically pleasant in appearance. The taped behaviors were pretested as being high, moderate, or low in expressive competence and technical competence. One analysis focused on the effect of high versus low technical skill on psychological symptom disclosure. In this experimental Vlll condition, the physician's level of expressive skill was controlled at a moderate level. A second analysis focused on the effect of high versus low expressive competence on psychological symptom disclosure. In this experimental condition, the physician's level of technical skill was controlled at a moderate level. Results indicated that physicians depicting high technical competence elicited greater willingness to disclose psychological symptoms from subjects than did physicians depicting low technical competence. Results also indicated significantly greater willingness on the part of male subjects to disclose psychological symptoms when they viewed the male physician. When level of expressive competence was manipulated, increased willingness to disclose psychological symptoms was found when physicians demonstrated high expressive competence, and in male physician-male subject dyads. The highest level of willingness to disclose psychological symptoms occurred when a male physician was depicted as having high expressive skill. Evidence was found suggesting that subjects may have espoused sex role stereotypes of male versus female physician behavior. Results indicated that, when the male physician behaved contrary to expectations for sex role stereotypes, he elicited greater willingness to disclose psychological symptoms from subjects than did a female physician who behaved comparably. IX Implications are drawn concerning the relative influence of technical versus expressive competence on psychological symptom disclosure, the physician-patient relationship, and medical service delivery.
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