Table Of ContentPERCEPTIONS OF PHYSICIAN BEHAVIOR:
THE EFFECT OF PHYSICIAN EXPRESSIVE AND TECHNICAL
COMPETENCE ON PSYCHOLOGICAL SYMPTOM DISCLOSURE
By
MIGUEL A. FRANCO
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE
UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1991
ACKNOWLEDGEMENT
There are many people I wish to thank for their
assistance, guidance, and friendship while I have been in
the counseling psychology program at the University of
Florida. Shae Kosch could not have been a better
supervisor. Not only was Shae supportive during difficult
times, she was the one who introduced me to the "real" world
of psychotherapy. Shae s patience and attention to detail
'
are what I am most grateful for.
Harry Grater is another person who played a major role
in my professional development. Harry's abilities to teach,
and stimulate me to listen to my inner voice in therapy are
what I am most grateful for.
I want to thank the Minority Fellowship Program for
making it financially possible for me to make it through
graduate school at the University of Florida.
Special thanks go to Linda Hellmich. I am happy that
we are in the same field.
Internship year played a critical role in my overall
development. When I was accepted as an intern at Notre
Dame/Oaklawn I had very high expectations. Rita Donley
almost single handedly surpassed all of these expectations.
11
I want to thank my mother, Myriam, and my father,
Antonio "Chuchito" Franco. I could not have done it without
their support.
I want to thank my big brother, Tony. Every kid needs
a "big" brother. I am grateful that I have him as mine.
I want to thank the rest of my family, Luly, Tio,
Abuela Kela, Abuelo Tin, Abuela Angelina and the boss,
Antonio "Chucho" Franco Tauler.
I want to thank my children, Candice and Daniel, for
bearing with me, and inspiring me. They are proof that God
works overtime.
Finally, I want to thank the most important person in
my life, my wife B.J. I dedicate this work to her.
Ill
TABLE OF CONTENTS
PAGE
ACKNOWLEDGEMENTS ii
LIST OF FIGURES vi
LIST OF TABLES vii
ABSTRACT vii
CHAPTERS
1. INTRODUCTION 1
2. REVIEW OF THE LITERATURE 6
....
Psychological Disorders in Primary Care 6
Cost Benefit Analysis of Treating
Psychological Concerns 8
Research on Physician-Patient Communication 11
. .
Therapist-Client Relationship and its
Salience to the Physician-Patient
Relationship 16
...
Psychological Research on Self-disclosure 21
Attributes of the Recipient of
Self-disclosure 22
....
Characteristics of the Disclosing Person 26
Properties of the Disclosure Situation 28
Topic or Content of Self-disclosure 33
Purpose of the Study 34
3. METHODS 43
The Videotaped Medical Interviews 45
Operational Definitions 46
Subjects 47
Procedure 47
Variables 48
Dependent Variables 53
Hypothesis Testing 56
IV
4. RESULTS 59
Pretest of the Expressive & Technical
Competence Manipulation 59
Demographics 61
Hypothesis 1 61
Hypothesis 2 67
Hypothesis 3 70
Hypothesis 4 71
General, Private, and Psychological Symptom
Disclosure 71
Correlational Analysis 75
5. DISCUSSION 78
Analysis of Hypotheses One and Four (ANOVA I) 79
.
Analysis of Hypothesis Two (ANOVA II) 89
Analysis of Hypothesis Three 91
Concluding Remarks
94
APPENDICES
A. SCRIPTS OF EXPRESSIVE SKILL/TECHNICAL SKILL
MANIPULATIONS
102
B. CONSENT FORM 112
C. SYMPTOMS QUESTIONNAIRE 113
D. SMITH-FALVO PATIENT-DOCTOR INTERACTION SCALE 116
. .
E. PRE TEST QUESTIONNAIRE 117
F. PRE TEST ANOVA SUMMARY TABLES 118
REFERENCES
121
BIOGRAPHICAL SKETCH
134
LIST OF FIGURES
Figure Page
4.1 ANOVA I Expressive Dimension Manipulation:
Physician Gender x Subject Gender
Interaction 65
4.2 ANOVA I Expressive Dimension Manipulation:
Physician Gender x Level of Expressive
Skill Interaction 66
4.3 ANOVA II Technical Dimension Manipulation:
Physician Gender x Subject Gender
Interaction 69
4.4 ANOVA IV High Expressive Dimension Condition:
Degree of Psychological Disclosure to
Male vs. Female Physician 73
VI
1
LIST OF TABLES
Tables Page
4 Population of Study 62
.
4.2 Hypothesis One: Expressive Skill
Manipulation Summary Table 63
4.3 Hypothesis One: Expressive Skill Manipulation
Test for Interaction Summary Table 63
4.4 Hypothesis Two: Technical Skill
Manipulation Summary Table 68
4.5 Hypothesis Two: Technical Skill Manipulation
Test for Interaction Summary Table 68
4.6 Hypothesis Four: Summary Table of High
Expressive Condition When Disclosing
Psychological Symptoms to a Male Versus
Female Physician 72
4.7 Hypoithesis Four: Summary Table of Test of
Interaction Between Subject and Physician
Gender When Disclosing Psychological
....
Symptoms to a High Expressive Physician 74
4.8 Correlations Between Degree of Psychological
Symptom Disclosure and Degree of Importance
of Physician Behaviors 76
vii
Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of
the Requirements for the Degree of Doctor of Philosophy
PERCEPTIONS OF PHYSICIAN BEHAVIOR:
THE EFFECT OF PHYSICIAN EXPRESSIVE AND TECHNICAL
COMPETENCE ON PSYCHOLOGICAL SYMPTOM DISCLOSURE
By
MIGUEL A. FRANCO
Chairman: Franz Epting, Ph.D.
Major Department: Psychology
Physician underdiagnosis of psychological symptoms is
well documented. This study investigates whether
perceptions of specific physician behaviors exert an effect
on willingness to disclose psychological symptoms.
Forty male and forty female subjects, imagining a
future visit of their own to two physicians viewed on
videotape, rated their willingness to disclose symptoms of a
general, private, and psychological nature to the male or
the female physician. The trigger videotapes were of a male
and female physician, in their mid-thirties, white, and
physically pleasant in appearance. The taped behaviors were
pretested as being high, moderate, or low in expressive
competence and technical competence. One analysis focused
on the effect of high versus low technical skill on
psychological symptom disclosure. In this experimental
Vlll
condition, the physician's level of expressive skill was
controlled at a moderate level. A second analysis focused
on the effect of high versus low expressive competence on
psychological symptom disclosure. In this experimental
condition, the physician's level of technical skill was
controlled at a moderate level.
Results indicated that physicians depicting high
technical competence elicited greater willingness to
disclose psychological symptoms from subjects than did
physicians depicting low technical competence. Results also
indicated significantly greater willingness on the part of
male subjects to disclose psychological symptoms when they
viewed the male physician.
When level of expressive competence was manipulated,
increased willingness to disclose psychological symptoms was
found when physicians demonstrated high expressive
competence, and in male physician-male subject dyads. The
highest level of willingness to disclose psychological
symptoms occurred when a male physician was depicted as
having high expressive skill.
Evidence was found suggesting that subjects may
have espoused sex role stereotypes of male versus female
physician behavior. Results indicated that, when the male
physician behaved contrary to expectations for sex role
stereotypes, he elicited greater willingness to disclose
psychological symptoms from subjects than did a female
physician who behaved comparably.
IX
Implications are drawn concerning the relative
influence of technical versus expressive competence on
psychological symptom disclosure, the physician-patient
relationship, and medical service delivery.
