Communication Apprehension and Fear of Physician in the Patients Referring to the Clinics of Rafsanjan University of Medical Sciences

Background and Aim: Communication Apprehension (CA) is "an individual's level of fear or anxiety associated with either real or anticipated communication with another person or persons." The role of communication in the health care settings has gained a lot attention in the past two decades. People who have high CA usually avoid or withdraw from communication, and this is the most common behavioral responses to high CA. A good and effective communication between physician and patient is the backbone of medical services. It has been reported that 50% of psychological and psychiatric problems are missed due to lack of effective communication between doctors and patients. Moreover, 54% of patient's problems and 45% of patients' concerns are neither elicited by the physician nor disclosed by the patients. Fear of physician is also a factor that impedes the communication process and leads to the withdrawal and communication avoidance on the part of the patients. Many patients are fearful and anxious about communicating with their physician. Of course this fear is a direct result of the way physician chooses to lead the communication process. This failure in the communication process can then quite easily lead to increase morbidity and mortality. This study aimed to determine the fear of physician and communication apprehension of the patients referring to the clinics of Rafsanjan University of Medical Sciences in 2015.  Materials and Methods : 150 patients were selected through quota sampling to participate in this study. Data gathering included a questionnaire which consisted of three parts: demographic information; Personal Report of Communication Apprehension questionnaire (PRCA 24; and the fear of physician (FOP) questionnaire. The criteria for entering the study included the followings: being a patient (referral to the clinic), complete alertness, consent for participation and being literate enough to complete the questioners. Upon leaving the physicians' office, the researchers who were in the clinics explained the purpose of the study to the patients and asked them to complete the questioners. Using a Likert-type 5-point scale, respondents indicated whether they strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree with each statement. The last instrument used in this study was fear of physician (FOP) which is based on a five item state anxiety measure developed by Spielberger in 1966. In this questioner each participant is asked to complete the measure about how tense, calm, jittery, nervous, and relaxed she/he feels when talking to the doctor. They respond as 1= not at all, 2= somewhat, 3= moderately so and 4= very much so. The scores over 13 indicate on high fear of physician and scores below 7 indicate on low fear. Scores in between indicate on moderate fear of physician. The data were analyzed using T Test, Fisher and Chi square by SPSS software version 18. Ethical considerations: Having obtained the approval of the Ethics Committee of Rafsanjan University of Medical Sciences, the participants were provided with the full information about the objectives of the study and how to answer the questionnaires. Patients consent for research participation was obtained and confidentiality was observed. Findings : The mean age of the participants was 31.31±9.78. The youngest participant was 13 and the oldest participant reported to be 63. 68% of the respondents were female and 32% were male and overall 30.7% of the participants were single. Regarding the job status, 31.1% of the participants had jobs in the governmental sections while 4.1% were unemployed. The rest were either self-employed or were farmers or laborers. Regarding the educational level, 36% had university degrees with 12.7% having graduate degrees; 33.3% had high school degree, and 18% had elementary school education. Overall, 57.3% had referred to the same clinic and physician for the first or second time, while 28.7% had referred to their physician for the third time and 14 % percent reported that this was their fourth or fifth visit. The mean of the PRCA 24 score was at medium level (71.3±6.46). The communication apprehension in 95.3% of the patients was medium but in 4.7% of the patients was high. The FOP analysis showed mean score of 12.97 ±2.99. The fear of physician in 64.6% of the patients was medium and in 35.4% of the patients was high. The mean scores in subgroups were as followings: group discussion: 21.08±4.09, interpersonal relationship: 20.55±4.01, public speaking 19.30±4.46 and meetings 20.28±4.17. Conclusion: As can be seen from the findings, the patients referring to the clinics indicated medium to high communication apprehension and high fear of physician. This problem is not something to be looked over and needs further investigation and intervention as in no doubt it will damage and impede the treatment process. It should be emphasized that effective treatment requires an effective communication between physician and patient. So, it is necessary for the patients to feel comfortable talking with the doctor. The patients should see themselves as a partner in the treatment process in order to receive the best care. Clinicians can incorporate into their practices an organized and systematic consideration of each patient as a unique individual. A "Patient's Review" that specifically addresses the preferences, values, and needs of each patient could also serve as a complement to the treatment process. Please cite this article as: Hashemi Z, Hadavi M, Valinejad M. Communication Apprehension and Fear of Physician in the Patients Referring to the Clinics of Rafsanjan University of Medical Sciences. Med Ethics J 2016; 10(37): 37-47.