Perceived likeability and competence of simulated patients: Influence on physicians' management plans

The goals of this study were to define the psychological and personality characteristics that physicians attribute to their patients and to determine whether these attributions affect treatment decisions. A Physician Attribution Survey was developed to achieve the first goal, and demonstrated that likeability and competence were salient features of the physician-patient relationship. Videotapes were then created demonstrating patients with three different combinations of likeability and competence: likeable-competent (L-C), unlikeable-competent (U-C) and likeable-incompetent (L-I). After being pre-tested with several samples of health professional students, the tapes were shown to 93 primary care physicians. These physicians then completed both a Physician Attribution Survey and a Patient Management Problem describing their proposed treatment. There were significant differences in treatment on five of nine treatment dimensions, depending upon the characteristics of the patient. First, the L-C patient would be encouraged significantly more often to telephone and to return more frequently for follow-up than would the L-I or U-C patient. Second, the staff would educate the likeable patients significantly more often than they would the unlikeable patients. Third, the physician would offer significantly more patient education to incompetent patients than to competent ones. Fourth, the unlikeable patient would receive significantly more interviewing regarding the psychological aspects of care than would the likeable patients. Fifth, the L-C patient would receive augmented medication more frequently than either the U-C patient or the L-I patient. There were no differences in the use of the physical examination, referral to staff, frequency of return or hospitalization based on the personal characteristics of the patient, although some of these variables were significantly affected by the attributed disease. There were no interactions between patient characteristics and disease as determinants of management. These findings have implications for medical education, studies of medical decision-making, and assessments of physicians' quality of care of patients. The methods developed provide a basis for more extensive and detailed studies of the explicit and implicit theories physicians have regarding the relationship between the personality characteristics of their patients and treatment decisions.