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Virtual reality evidence on the impact of physicians' open versus defensive communication on patients

Published online by Cambridge University Press:  01 December 2023

Lotte Daniels*
Affiliation:
Faculty of Business Economics, Hasselt University, 3500 Hasselt, Belgium
Wim Marneffe
Affiliation:
Faculty of Business Economics, Hasselt University, 3500 Hasselt, Belgium
Samantha Bielen
Affiliation:
Faculty of Business Economics, Hasselt University, 3500 Hasselt, Belgium
*
Corresponding author: Lotte Daniels; Email: lotte.daniels@uhasselt.be

Abstract

Using virtual reality (VR) in an experimental setting, we analyse how communicating more openly about a medical incident influences patients' feelings and behavioural intentions. Using VR headsets, participants were immersed in an actual hospital room where they were told by a physician that a medical incident had occurred. In a given scenario, half of the participants were confronted by a physician who communicated openly about the medical incident, while the other half were confronted with the exact same scenario except that the physician employed a very defensive communication strategy. The employed technology allowed us to keep everything else in the environment constant. Participants exposed to open disclosure were significantly more likely to take further steps (such as contacting a lawyer to discuss options and filing a complaint against the hospital) and express more feelings of blame against the physician. At the same time, these participants rated the physician's communication skills and general impression more highly than those who were confronted with a defensive physician. Nevertheless, communicating openly about the medical incident does not affect trust in the physician and his competence, perceived incident severity and likelihood of changing physician and filing suit.

Type
Article
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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References

Allan, A and McKillop, D (2010) The health implications of apologizing after an adverse event. International Journal for Quality in Health Care 22, 126131. https://doi.org/10.1093/intqhc/mzq001CrossRefGoogle ScholarPubMed
Allan, A, McKillop, D, Dooley, J, Allan, MM and Preece, DA (2015) Apologies following an adverse medical event: the importance of focusing on the consumer's needs. Patient Education and Counseling 98, 10581062. https://doi.org/10.1016/j.pec.2015.06.001CrossRefGoogle ScholarPubMed
Amaral-Garcia, S, Bertoli, P and Grembi, V (2015) Does experience rating improve obstetric practices? Evidence from Italy. Health Economics 24, 10501064. https://doi.org/10.1002/hec.3210CrossRefGoogle ScholarPubMed
Ambady, N, LaPlante, D, Nguyen, T, Rosenthal, R, Chaumeton, N and Levinson, W (2002) Surgeons’ tone of voice: a clue to malpractice history. Surgery 132, 59. https://doi.org/10.1067/msy.2002.124733CrossRefGoogle Scholar
Anderson, LA and Dedrick, RF (1990) Development of the trust in physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychological Reports 67(3_suppl), 10911100.Google Scholar
Aruguete, MS and Roberts, CA (2000) Gender, affiliation, and control in physician–patient encounters. Sex Roles 42, 107118. https://doi.org/10.1023/a:1007036412480CrossRefGoogle Scholar
Aruguete, MS and Roberts, CA (2002) Participants’ ratings of male physicians who vary in race and communication style. Psychological Reports 91, 793806. https://doi.org/10.2466/pr0.2002.91.3.793CrossRefGoogle ScholarPubMed
Avraham, R and Schanzenbach, M (2015) The impact of tort reform on intensity of treatment: evidence from heart patients. Journal of Health Economics 39, 273288. https://doi.org/10.1016/j.jhealeco.2014.08.002CrossRefGoogle ScholarPubMed
Bielen, S, Grajzl, P and Marneffe, W (2019) Investigating medical malpractice victim compensation: micro-level evidence from a professional liability insurer's files. The European Journal of Health Economics 20, 12491260.CrossRefGoogle ScholarPubMed
Bielen, S, Grajzl, P and Marneffe, W (2020) The resolution process and the timing of settlement of medical malpractice claims. Health Economics, Policy and Law 15, 509529. https://doi.org/10.1017/S1744133119000185CrossRefGoogle ScholarPubMed
Blascovich, J, Loomis, J, Beall, AC, Swinth, KR, Hoyt, CL and Bailenson, JN (2002) Immersive virtual environment technology: just another methodological tool for social psychology? Psychological Inquiry 13, 146149. https://doi.org/10.1207/S15327965PLI1302_03CrossRefGoogle Scholar
Blendon, RJ, DesRoches, CM, Brodie, M, Benson, JM, Rosen, AB, Schneider, E, Altman, DE, Zapert, K, Herrmann, MJ and Steffenson, AE (2002) Views of practicing physicians and the public on medical errors. The New England Journal of Medicine 347, 19331940.CrossRefGoogle ScholarPubMed
Bradford, WD (1995) Solo versus group practice in the medical profession: the influence of malpractice risk. Health Economics 4, 95112. https://doi.org/10.1002/hec.4730040203CrossRefGoogle ScholarPubMed
Bradley, G, Sparks, B and Nesdale, D (2001) Doctor communication style and patient outcomes: gender and age as moderators. Journal of Applied Social Psychology 31, 17491773. https://doi.org/10.1111/j.1559-1816.2001.tb02749.xCrossRefGoogle Scholar
Brugel, S, Postma-Nilsenová, M and Tates, K (2015) The link between perception of clinical empathy and nonverbal behavior: the effect of a doctor's gaze and body orientation. Patient Education and Counseling 98, 12601265. https://doi.org/10.1016/j.pec.2015.08.007CrossRefGoogle ScholarPubMed
Carey, K and Stefos, T (2011) Measuring the cost of hospital adverse patient safety events. Health Economics 20, 14171430. https://doi.org/10.1002/hec.1680CrossRefGoogle ScholarPubMed
Cha, ES, Kim, KH and Erlen, JA (2007) Translation of scales in cross-cultural research: issues and techniques. Journal of Advanced Nursing 58, 386395.CrossRefGoogle ScholarPubMed
Charness, G, Gneezy, U and Kuhn, MA (2012) Experimental methods: between-subject and within-subject design. Journal of Economic Behavior & Organization 81, 18.CrossRefGoogle Scholar
Coke, JS, Batson, CD and McDavis, K (1978) Empathic mediation of helping: a two-stage model. Journal of Personality and Social Psychology 36, 752766.CrossRefGoogle Scholar
Coombs, WT and Holladay, SJ (2002) Helping crisis managers protect reputational assets: initial tests of the situational crisis communication theory. Management Communication Quarterly 16, 165186.CrossRefGoogle Scholar
Coughlan, B, Powell, D and Higgins, M (2017) The second victim: a review. European Journal of Obstetrics & Gynecology and Reproductive Biology 213, 1116.CrossRefGoogle ScholarPubMed
Dupont, WD and Plummer, WD Jr (1998) Power and sample size calculations for studies involving linear regression. Controlled Clinical Trials 19, 589601.CrossRefGoogle ScholarPubMed
FMO (2020) Activiteitenverslag van het Fonds Voor de Medische Ongevallen – 2020. Belgium: RIZIV.Google Scholar
Gallagher, TH, Waterman, AD, Ebers, AG, Fraser, VJ and Levinson, W (2003) Patients’ and physicians’ attitudes regarding the disclosure of medical errors. JAMA 289, 10011007.CrossRefGoogle ScholarPubMed
Gallagher, TH, Garbutt, JM, Waterman, AD, Flum, DR, Larson, EB, Waterman, BM, Dunagan, WC, Fraser, VJ and Levinson, W (2006) Choosing your words carefully: how physicians would disclose harmful medical errors to patients. JAMA Internal Medicine 166, 15851593. https://doi.org/10.1001/archinte.166.15.1585Google ScholarPubMed
Gallagher, TH, Studdert, D and Levinson, W (2007) Disclosing harmful medical errors to patients. The New England Journal of Medicine 356, 27132719.CrossRefGoogle ScholarPubMed
Garattini, L and Padula, A (2020) Defensive medicine in Europe: a ‘full circle’? European Journal of Health Economics 21, 165170. https://doi.org/10.1007/s10198-019-01144-0CrossRefGoogle ScholarPubMed
Gerbert, B, Berg-Smith, S, Mancuso, M, Caspers, N, Danley, D, Herzig, K and Brand, R (2003) Video study of physician selection: preferences in the face of diversity. Journal of Family Practice 52, 552559.Google ScholarPubMed
Green, MC and Brock, TC (2000) The role of transportation in the persuasiveness of public narratives. Journal of Personality and Social Psychology 79, 701721.CrossRefGoogle ScholarPubMed
Grégoire, Y, Tripp, TM and Legoux, R (2009) When customer love turns into lasting hate: the effects of relationship strength and time on customer revenge and avoidance. Journal of Marketing 73, 1832.CrossRefGoogle Scholar
Hannawa, AF (2011) Shedding light on the dark side of doctor–patient interactions: verbal and nonverbal messages physicians communicate during error disclosures. Patient Education and Counseling 84, 344351. https://doi.org/10.1016/j.pec.2011.04.030CrossRefGoogle ScholarPubMed
Hannawa, AF (2012) ‘ Explicitly implicit’: examining the importance of physician nonverbal involvement during error disclosures. Swiss Medical Weekly 142, w13576.Google ScholarPubMed
Hannawa, AF (2014) Disclosing medical errors to patients: effects of nonverbal involvement. Patient Education and Counseling 94, 310313. https://doi.org/10.1016/j.pec.2013.11.007CrossRefGoogle ScholarPubMed
Hannawa, AF, Beckman, H, Mazor, KM, Paul, N and Ramsey, JV (2013) Building bridges: future directions for medical error disclosure research. Patient Education and Counseling 92, 319327. https://doi.org/10.1016/j.pec.2013.05.017CrossRefGoogle ScholarPubMed
Hannawa, AF, Shigemoto, Y and Little, TD (2016) Medical errors: disclosure styles, interpersonal forgiveness, and outcomes. Social Science & Medicine 156, 2938. https://doi.org/10.1016/j.socscimed.2016.03.026CrossRefGoogle ScholarPubMed
Hillen, MA, van Vliet, LM, de Haes, HC and Smets, EM (2013) Developing and administering scripted video vignettes for experimental research of patient-provider communication. Patient Education and Counseling 91, 295309. 10.1016/j.pec.2013.01.020CrossRefGoogle ScholarPubMed
Iedema, R, Allen, S, Britton, K, Piper, D, Baker, A, Grbich, C, Allan, A, Jones, L, Tuckett, A and Williams, A (2011) Patients’ and family members’ views on how clinicians enact and how they should enact incident disclosure: the ‘100 patient stories’ qualitative study. BMJ 343, d4423.CrossRefGoogle ScholarPubMed
James, JT (2013) A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety 9, 122128.CrossRefGoogle ScholarPubMed
Jena, AB, Seabury, SA, Lakdawalla, DN and Chandra, A (2011) Malpractice risk according to physician specialty. New England Journal of Medicine 365, 629636. https://doi.org/10.1056/NEJMsa1012370CrossRefGoogle ScholarPubMed
Joireman, J, Grégoire, Y, Devezer, B and Tripp, TM (2013) When do customers offer firms a ‘second chance’ following a double deviation? The impact of inferred firm motives on customer revenge and reconciliation. Journal of Retailing 89, 315337.CrossRefGoogle Scholar
Jonas, HS, Etzel, SI and Barzansky, B (1992) Educational programs in us medical schools. JAMA 268, 10831090.CrossRefGoogle ScholarPubMed
Kachalia, A, Kaufman, SR, Boothman, RC, Anderson, S, Welch, K, Saint, S and Rogers, MAM (2010) Liability claims and costs before and after implementation of a medical error disclosure program. Annals of Internal Medicine 153, 213222. https://doi.org/10.1059/0003-4819-153-4-201008170-00002CrossRefGoogle ScholarPubMed
Kachalia, A, Sands, K, Niel, MV, Dodson, S, Roche, S, Novack, V, Yitshak-Sade, M, Folcarelli, P, Benjamin, EM, Woodward, AC and Mello, MM (2018) Effects of a communication-and-resolution program on hospitals’ malpractice claims and costs. Health Affairs 37, 18361844. https://doi.org/10.1377/hlthaff.2018.0720CrossRefGoogle ScholarPubMed
Kessler, D and McClellan, M (1996) Do doctors practice defensive medicine? The Quarterly Journal of Economics 111, 353390.CrossRefGoogle Scholar
Kessler, D, Sage, W and Becker, D (2005) Impact of malpractice reforms on the supply of physician services. JAMA 293, 26182625. https://doi.org/10.1001/jama.293.21.2618CrossRefGoogle ScholarPubMed
Klingman, D, Localio, AR, Sugarman, J, Wagner, JL, Polishuk, PT, Wolfe, L and Corrigan, JA (1996) Measuring defensive medicine using clinical scenario surveys. Journal of Health Politics, Policy and Law 21, 185220.CrossRefGoogle ScholarPubMed
Lawthers, AG, Localio, AR, Laird, NM, Lipsitz, S, Hebert, L and Brennan, TA (1992) Physicians’ perceptions of the risk of being sued. Journal of Health Politics Policy and Law 17, 463482.CrossRefGoogle ScholarPubMed
Lester, GW and Smith, SG (1993) Listening and talking to patients: a remedy for malpractice suits? Western Journal of Medicine 158, 268272. https://doi.org/10.1097/00006254-199310000-00012Google ScholarPubMed
Levinson, W (2009) Disclosing medical errors to patients: a challenge for health care professionals and institutions. Patient Education and Counseling 76, 296299.CrossRefGoogle ScholarPubMed
Levinson, W, Roter, DL, John, P and Dull, VT (1997) Physician-patient communication relationship with malpractice claim. JAMA 277, 553559.CrossRefGoogle Scholar
Mazor, KM, Simon, SR, Yood, RA, Martinson, BC, Gunter, MJ, Reed, GW and Gurwitz, JH (2004) Health plan members’ views about disclosure of medical errors. Annals of Internal Medicine 140, 409418. https://doi.org/10.7326/0003-4819-140-6-200403160-00006CrossRefGoogle ScholarPubMed
Mazor, KM, Reed, GW, Yood, RA, Fischer, MA, Baril, J and Gurwitz, JH (2006) Disclosure of medical errors: what factors influence how patients respond? Journal of General Internal Medicine 21, 704710. https://doi.org/10.1111/j.1525-1497.2006.00465.xCrossRefGoogle ScholarPubMed
Mello, BMM, Boothman, RC, Mcdonald, T, Driver, J, Lembitz, A, Bouwmeester, D, Dunlap, B and Gallagher, T (2014) Communication-and-resolution programs: the challenges and lessons learned from six early adopters. Health Affairs 33, 2029.CrossRefGoogle ScholarPubMed
Mokas, I, Lizin, S, Brijs, T, Witters, N and Malina, R (2021) Can immersive virtual reality increase respondents’ certainty in discrete choice experiments? A comparison with traditional presentation formats. Journal of Environmental Economics and Management 109, 102509. https://doi.org/10.1016/j.jeem.2021.102509CrossRefGoogle Scholar
Moore, PJ, Adler, NE and Robertson, PA (2000) Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions. Western Journal of Medicine 173, 244250. https://doi.org/10.1136/ewjm.173.4.244CrossRefGoogle ScholarPubMed
Moore, J, Bismark, M and Mello, MM (2017) Patients’ experiences with communication-and-resolution programs after medical injury. JAMA Internal Medicine 177, 15951603. https://doi.org/10.1001/jamainternmed.2017.4002CrossRefGoogle ScholarPubMed
Nazione, S and Pace, K (2015) An experimental study of medical error explanations: do apology, empathy, corrective action, and compensation alter intentions and attitudes? Journal of Health Communication 20, 14221432. https://doi.org/10.1080/10810730.2015.1018646CrossRefGoogle ScholarPubMed
OECD (2015) Fiscal Sustainability of Health Systems: Bridging Health and Finance Perspectives. Paris: OECD Publishing.Google Scholar
Osti, M and Steyrer, J (2017) A perspective on the health care expenditures for defensive medicine. The European Journal of Health Economics 18, 399404. https://doi.org/10.1007/s10198-016-0848-4CrossRefGoogle ScholarPubMed
OTA (1994) Defensive Medicine and Medical Malpractice. Washington, WA: U.S. Government Printing Office.Google Scholar
Patterson, Z, Darbani, JM, Rezaei, A, Zacharias, J and Yazdizadeh, A (2017) Comparing text-only and virtual reality discrete choice experiments of neighbourhood choice. Landscape and Urban Planning 157, 6374.CrossRefGoogle Scholar
Pingitore, R, Dugoni, BL, Tindale, RS and Spring, B (1994) Bias against overweight job applicants in a simulated employment interview. Journal of Applied Psychology 79, 909.CrossRefGoogle Scholar
Roberfroid, D, Stordeur, S, Camberlin, C, Van de Voorde, C, Vrijens, F and Leonard, C (2008) Physician Workforce Supply in Belgium: Current Situation and Challenges. Brussels: Belgian Health Care Knowledge Centre (KCE).Google Scholar
Roberts, CA and Aruguete, MS (2000) Task and socioemotional behaviors of physicians: a test of reciprocity and social interaction theories in analogue physician–patient encounters. Social Science & Medicine 50, 309315. https://doi.org/10.1016/S0277-9536(99)00245-2CrossRefGoogle ScholarPubMed
Roberts, B and Hoch, I (2007) Malpractice litigation and medical costs in Mississippi. Health Economics 16, 841859. https://doi.org/10.1002/hec.1195CrossRefGoogle ScholarPubMed
Rollnick, S, Mason, P and Butler, C (2001) Health Behavior Change: A Guide for Practitioners. Edinburgh, UK: Churchill Livingstone.Google Scholar
Saha, S and Beach, MC (2011) The impact of patient-centered communication on patients’ decision making and evaluations of physicians: a randomized study using video vignettes. Patient Education and Counseling 84, 386392. https://doi.org/10.1016/j.pec.2011.04.023CrossRefGoogle ScholarPubMed
Schoenfeld, EM, Mader, S, Houghton, C, Wenger, R, Probst, MA, Schoenfeld, DA, Lindenauer, PK and Mazor, KM (2019) The effect of shared decisionmaking on patients ’ likelihood of filing a complaint or lawsuit: a simulation study. Annals of Emergency Medicine 74, 126136. https://doi.org/10.1016/j.annemergmed.2018.11.017CrossRefGoogle ScholarPubMed
Schulman, KA, Jesse, A, Harless, W, Kerner, JF, Sistrunk, S, Gersch, BJ, Phil, D, Dubé, R, Taleghani, CK, Burke, JE, Williams, S, Eisenberg, JM and Escarce, JJ (1999) Misunderstandings about the effects of race and sex on physicians’ referrals for cardiac catheterization. New England Journal of Medicine 340, 618626. https://doi.org/10.1055/s-2005-869823CrossRefGoogle Scholar
Seys, D, Scott, S, Wu, A, Van Gerven, E, Vleugels, A, Euwema, M, Panella, M, Conway, J, Sermeus, W and Vanhaecht, K (2013) Supporting involved health care professionals (second victims) following an adverse health event: a literature review. International Journal of Nursing Studies 50, 678687.CrossRefGoogle ScholarPubMed
Shapiro, DE, Boggs, SR, Melamed, BG and Graham-Pole, J (1992) The effect of varied physician affect on recall, anxiety, and perceptions in women at risk for breast cancer: an analogue study. Health Psychology 11, 6166. https://doi.org/10.1037/0278-6133.11.1.61CrossRefGoogle ScholarPubMed
Shurtz, I (2013) The impact of medical errors on physician behavior: evidence from malpractice litigation. Journal of Health Economics 32, 331340. https://doi.org/10.1016/j.jhealeco.2012.11.011CrossRefGoogle ScholarPubMed
Slater, M and Wilbur, S (1997) A framework for immersive virtual environments (five): speculations on the role of presence in virtual environments. Presence 6, 603616.CrossRefGoogle Scholar
Sloan, FA and Shadle, JH (2009) Is there empirical evidence for ‘defensive medicine’? A reassessment. Journal of Health Economics 28, 481491. https://doi.org/10.1016/j.jhealeco.2008.12.006CrossRefGoogle ScholarPubMed
Strasser, F, Palmer, JL, Willey, J, Shen, L, Shin, K, Sivesind, D, Beale, E and Bruera, E (2005) Impact of physician sitting versus standing during inpatient oncology consultations: patients’ preference and perception of compassion and duration. A randomized controlled trial. Journal of Pain and Symptom Management 29, 489497.CrossRefGoogle ScholarPubMed
Studdert, DM, Mello, MM, Sage, WM, Desroches, CM, Peugh, J, Zapert, K and Brennan, TA (2005) Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 293, 26092617.CrossRefGoogle Scholar
Ullström, S, Sachs, MA, Hansson, J, Øvretveit, J and Brommels, M (2014) Suffering in silence: a qualitative study of second victims of adverse events. BMJ Quality & Safety 23, 325331.CrossRefGoogle ScholarPubMed
Van Gelder, J-L, De Vries, RE, Demetriou, A, Van Sintemaartensdijk, I and Donker, T (2019) The virtual reality scenario method: moving from imagination to immersion in criminal decision-making research. Journal of Research in Crime and Delinquency 56, 451480.CrossRefGoogle Scholar
Van Vliet, LM, Van Der Wall, E, Albada, A, Spreeuwenberg, PM, Verheul, W and Bensing, JM (2012) The validity of using analogue patients in practitioner–patient communication research: systematic review and meta-analysis. Journal of General Internal Medicine 27, 15281543.CrossRefGoogle ScholarPubMed
van Vliet, LM, Hillen, MA, van der Wall, E, Plum, N and Bensing, JM (2013) How to create and administer scripted video-vignettes in an experimental study on disclosure of a palliative breast cancer diagnosis. Patient Education and Counseling 91, 5664. https://doi.org/10.1016/j.pec.2012.10.017CrossRefGoogle Scholar
Vandersteegen, T, Vandijck, D and Marneffe, W (2015) Physician specialists’ perceptions of the medical malpractice system in Belgium. European Journal of Health Law 22, 481491. https://doi.org/10.1163/15718093-12341373CrossRefGoogle ScholarPubMed
Verheul, W, Sanders, A and Bensing, J (2010) The effects of physicians’ affect-oriented communication style and raising expectations on analogue patients’ anxiety, affect and expectancies. Patient Education and Counseling 80, 300306. https://doi.org/10.1016/j.pec.2010.06.017CrossRefGoogle ScholarPubMed
Visser, LN, Tollenaar, MS, Bosch, JA, van Doornen, LJ, de Haes, HC and Smets, EM (2016) Analogue patients’ self-reported engagement and psychophysiological arousal in a video-vignettes design: patients versus disease-naive individuals. Patient Education and Counseling 99, 17241732. https://doi.org/10.1016/j.pec.2016.04.012CrossRefGoogle Scholar
Willson, P and McNamara, JR (1982) How perceptions of a simulated physician-patient interaction influence intended satisfaction and compliance. Social Science & Medicine 16, 16991704. https://doi.org/10.1016/0277-9536(82)90095-8CrossRefGoogle ScholarPubMed
Wu, AW and Steckelberg, RC (2012) Medical error, incident investigation and the second victim: doing better but feeling worse? BMJ 21, 267270.Google ScholarPubMed
Wu, AW, Huang, I-C, Stokes, S and Pronovost, PJ (2009) Disclosing medical errors to patients: it's not what you say, it's what they hear. Journal of General Internal Medicine 24, 10121017. https://doi.org/10.1007/s11606-009-1044-3CrossRefGoogle Scholar
Wu, AW, Boyle, DJ, Wallace, G and Mazor, KM (2013) Disclosure of adverse events in the United States and Canada: an update, and a proposed framework for improvement. Journal of Public Health Research 2, 186193. https://doi.org/10.4081/jphr.2013.e32CrossRefGoogle Scholar