Date of Award

Summer 6-22-2015

Degree Type


Degree Name

PhD Health Sciences


Health and Medical Sciences


Terrence F. Cahill, Ed.D

Committee Member

Lee Cabell, Ed.D

Committee Member

Deborah DeLuca, J.D.


physician communication, midlevel communication, physician-patient communication, midlevel-patient communication, prompt care communication


Background: In recent years, a chief patient complaint has been that there is a breakdown in communication with their healthcare provider. This is concerning because poor provider-patient communication can lead to reduced medication adherence, misdiagnosis, increased healthcare costs, and even death. Furthermore, the implementation of the Affordable Care Act has availed healthcare insurance to more individuals, which will increase the insured patient population. This will lead to a rise in patient visits, but also means that there are not enough physicians to support this new volume of patients. Other healthcare providers, like nurse practitioners and physicians assistants are more likely to be engaged with patients, because of these increased demands. Therefore, understanding how patients perceive communication in all of these groups is essential because, as aforementioned, a lack of good communication can have grave consequences. The purpose of this study was to understand the patient’s perception of the medical doctor-patient communication encounter, the patient’s perceptions of the midlevel-patient communication encounter, and to identify the patient’s perceptions of difference between the two groups.

Methods: The research design for this study was descriptive, correlational and cross-sectional. The study engaged a convenience sample of 137 treat and release patients at the emergency department (ED) of Hackensack University Medical Center (HUMC).

Results: The survey utilized in this study consisted of two parts: the Communication Assessment Tool (CAT) (Makoul, 2007, Appendix A) and the Demographic Questionnaire. The CAT consisted of fourteen items where each item addressed a different aspect of the patient-provider communication encounter. Each item employed the following five-point Likert type scale: 1 = poor, 2 = fair, 3 = good, 4 = very good, 5 = excellent. The Demographic Questionnaire (Appendix B) was developed by the researcher and asked the patient to self-identify in the following five areas: age, gender, ethnicity, educational level, and employment status. The following shows the results of each research question.

Findings 1: The fact that both the mean and median CAT Composite scores for this segment of the sample were very high (M = 65.13 and Mdn = 67 on a 14-70 scale) showed that patients were extremely satisfied with their doctors’ communication skills.

Findings 2: While both the mean and median scores for this segment (M = 54.34 and Mdn = 56) suggested that patients were quite satisfied with their midlevel providers’ communication skills, their degree of satisfaction was not quite as high as those who dealt with physicians.

Findings 3: The perception of the physicians is better than their midlevel counterparts; reject null hypothesis.

Findings 4: The perception of the physicians is better in each of the fourteen areas versus their midlevel counterparts; reject null hypothesis.

Demographic Questionnaire Findings: While not considered as a formal research question, the final component of this study focused on whether demographics have an influence on patients’ overall perceptions of their healthcare providers’ communication skills as measured by the CAT composite score; none of the five demographics examined – age, gender, ethnicity, education, and employment status – had any significant influence.

Conclusion: Although past research shows that midlevel providers perform better than their physician counterparts, this study indicates differently. This is explained by the uniqueness of the hospital setting, where this study was conducted. In addition, further evidence-based research and longitudinal studies are recommended to compare with the results of this study. Future research may include hospitals in different geographic areas, further variation in practitioner groups, and a comparison of teaching versus non-teaching hospitals.