Document Detail


How stressful is doctor-patient communication? Physiological and psychological stress of medical students in simulated history taking and bad-news consultations.
MedLine Citation:
PMID:  20399815     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Medical communication can be a stressful experience for both doctors and patients. In particular, inexperienced doctors facing the demanding task of a bad news consultation may experience high levels of distress. The aim of this exploratory study is to test students' differential cardiovascular reactivity to history taking and bad news consultations with a simulated patient, and to test the relation between the students' self-reported stressfulness of the consultation and their cardiovascular response.
METHODS: Fourth and fifth year medical students (n=20) conducted a history taking (HT) and a bad news (BN) consultation in a randomized order with a standardized patient. Heart rate (HR), mean arterial pressure (MAP), cardiac output (CO) and systemic vascular resistance (SVR) were assessed by way of the Finapres-technique in four conditions: rest, reading aloud, and during both consultations. Self-reported stress was assessed before and after each interview using the State and Trait Anxiety Inventory (STAI), and a visual analogue scale (VAS).
RESULTS: Both HT and BN provoked more cardiovascular stress than reading. Bad-news provoked the highest HR and CO responses compared to all other conditions, and had a greater impact when it was the student's first consultation. The STAI and VAS data showed some correlations with the cardiovascular stress measures and a comparable but less significant pattern in stress response.
DISCUSSION: The effect of order of the HT and BN consultations on the students' stress levels suggests an additional impact of novelty and habituation. Unfamiliarity with the patient may enhance the stressfulness of the task of breaking bad news.
Authors:
Robert L Hulsman; Susan Pranger; Stephanie Koot; Marcel Fabriek; John M Karemaker; Ellen M A Smets
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2010-04-23
Journal Detail:
Title:  International journal of psychophysiology : official journal of the International Organization of Psychophysiology     Volume:  77     ISSN:  1872-7697     ISO Abbreviation:  Int J Psychophysiol     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-04     Completed Date:  2011-01-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8406214     Medline TA:  Int J Psychophysiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  26-34     Citation Subset:  IM    
Copyright Information:
2010 Elsevier B.V. All rights reserved.
Affiliation:
Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands. R.L.Hulsman@amc.uva.nl
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Pressure / physiology*
Clinical Competence
Communication
Female
Heart Rate / physiology*
Humans
Male
Patient Simulation*
Physician-Patient Relations*
Referral and Consultation
Stress, Psychological / physiopathology,  psychology
Students, Medical / psychology*
Truth Disclosure*
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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