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This study formulates a new archetypical model that describes and re-interprets the patient–physician relationship from the perspective of two widespread phenomena in the healthcare delivery process: value co-creation (VCC) and defensive medicine (DM).

Grounded in the existing literature on VCC and DM, the authors designed and conducted 20 in-depth interviews with doctors (and patients) about their past relationships with patients (and doctors). After putting the recorded interviews through qualitative analysis with a three-level coding activity, the authors built an empirically informed model to classify patient–physician relationships.

The authors identified four archetypes of patient–physician relationships. Each archetype is described along with its representing characteristics and explained in terms of its consequences as they relate to VCC and DM.

This research contributes to the literature on both VCC in healthcare and DM, in addition to the patient–physician's relationship literature.

Being aware of patient–physician relationship mechanics, building long-term relations with patients and investing in service personalization and patient-centred care can effectively mitigate the risks of DM behaviours on one side while increasing the likelihood of VCC actualization on the other.

Although strictly linked to the interactions between patients and doctors, VCC and DM are typically considered disentangled. In this research paper, the authors identified four archetypes of patient–physician relationships in relation to these two phenomena.

Online trust is a key factor for successful online transactions. To some extent, online health consultation can be considered an online transaction. Owing to the unique physician–patient relationship, patients' choice of physicians within an online health consultation setting may not only be based on rational judgments but also considerably affected by their feelings. Hence, the purpose of this study was to explore which physicians' attributes affect patients' cognitive and affective trust in physicians, as well as how these two variables and their association affect patients' willingness to choose.

Based on the broad conceptual framework of online trust, this paper proposed a set of hypotheses that were tested through analyzing survey data using structural equation modeling techniques.

Results showed that physicians' ability had a significant positive influence on patients' cognitive trust in the physician; physicians' integrity and benevolence had a significant positive influence on patients' affective trust in the physician; cognitive and affective trust had a significant positive impact on patients' willingness to choose and there were significant positive interactions between affective and cognitive trust.

This study theoretically enriches the generic model of online trust. From the practical perspective, it will provide physicians working in online health consultation platforms and relevant practitioners with baseline information on the topic and advice for decision-making toward service enhancement and clientele improvements.

Several trends such as improved access to health care information via the internet, the growth of self‐help groups and expenditure on alternative medicine signals consumers are taking an active role in their own health management. Chronic illnesses such as diabetes and asthma require a significant amount of self‐management and thus call for a collaborative patient‐physician relationship. This study explores whether empowering patient‐physician consultations measured through three patient empowerment dimensions (patient control, patient participation, physician support) enhance patients trust in and commitment to their physician.

A comprehensive mail survey of adults registered with one of four different chronic illness associations in Australia was conducted to collect the data.

The structural equation modelling results show that patients are more trusting of and committed to physicians who adopt an empowering communication style with them.

This study focuses on the Australian healthcare context. Thus, future multinational studies should explore suitable strategies to empower healthcare consumers that build on the constraints placed by diverse healthcare systems.

In a managed health care and cost cutting climate where patient trust is deteriorating, these findings suggest that empowering patients presents a means to improve the patient‐physician relationship.

Whilst numerous marketing scholars have researched the empowerment of staff, there is a shortage of studies that address the meaning and outcomes of consumer empowerment. This study proposes a unique communication based consumer empowerment construct which is shown to impact on consumer‐service provider relationships.

The aim of this research is to uncover issues that inhibit patients' satisfaction and loyalty and identify factors that could enhance customer retention by government hospitals in the United Arab Emirates (UAE). The mediating impact of outpatient satisfaction on service quality, word of mouth (WoM), hospital image, outpatient–physician relationship and outpatient loyalty were tested.

The sample data used to test the hypotheses were drawn from a pool of patients served by a government healthcare agency in Abu Dhabi. Questionnaires were provided to 418 participants using methods such as short message service, e-mail and face-to-face delivery. The data were analyzed using SmartPLS 3.3.2 software.

The results indicate that service quality, WoM and outpatient–physician relationship positively impact outpatient satisfaction and indirectly effect outpatient loyalty; that hospital image positively impacts outpatient satisfaction and loyalty and has a partially mediating effect on loyalty; that waiting time satisfaction has no effect on outpatient satisfaction and no moderating effect on the outpatient satisfaction–loyalty relationship and that switching cost has a positive effect on loyalty but no moderating effect on the outpatient satisfaction–loyalty relationship.

The first limitation of this study concerns the fact that only patients who had previously been served by these hospitals' outpatient units were included. Furthermore, the research was not able to obtain extensive findings related to the various factors that negatively impacted patient satisfaction and loyalty among all of the departments of government hospitals, such as inpatient care and emergency care.

Centered on the findings from this research, increasing switching costs would prevent patients from switching to other healthcare providers. Therefore, it has the potential to create a false loyalty or a hostage customer (Jones and Sasser, 1995). Additionally, making patients feel connected to their treatment plan and engaged in their care by developing a tool to maintain their enthusiasm about their health is important. It is therefore recommended that government hospital care providers and management consider providing online tools that patients can use to self-manage their care.

The results regarding patients' satisfaction level suggest several areas for improvement. The first pertains to waiting area entertainment and comfort because patients indicated that there is not enough entertainment or ways to pass the time when waiting for services. In addition to enhancing the entertainment and comfort of waiting areas, government hospital staff should maintain contact with patients who are waiting to ensure that they are aware of the time they will spend. Another area for improvement is the parking lot. During summer, patients prefer to walk less in the sun, which causes them to seek parking closer to the door. Government hospital management should consider different methods for transporting patients closer to the door, such as golf carts or valet services.

This is the first study to investigate the mediating impact of outpatients' satisfaction between its antecedents and loyalty in the UAE. These results provide an improved understanding of the factors influencing patient choices and establish more accurate methods for increasing patient loyalty to retain more patients.

The purpose of this paper is to examine factors that may contribute to physicians’ dissatisfaction with their work environment, and subsequently, their likelihood to recommend a hospital to their peers.

A mixed method research design was used to identify, through qualitative interviews and focus groups, and measure, through quantitative surveys, physicians’ satisfaction with organizational communication, perceptions of empowerment and their likelihood to recommend a hospital to their peer physicians.

The results of the study indicate that physicians’ communication satisfaction and perceptions of empowerment contribute both directly and indirectly to their likelihood to recommend their organization to peers. The findings suggest that hospitals that facilitate positive workplace communications and provide work environments that allow professional discretion and autonomy are more likely to have satisfied physicians and positive word‐of‐mouth referrals.

Although multiple methods of data collection were used to triangulate the findings, there is the potential of common‐method variance and response bias from the use of single source questionnaire data. Ideally, future studies would use longitudinal data and a more comprehensive model of antecedents and consequences of physician satisfaction.

By understanding sources of physician dissatisfaction, hospitals can develop appropriate interventions to minimize the adverse effects of dissatisfaction on costs, quality of care, and physician turnover.

This study focuses on physicians’ satisfaction with their hospital work environment, an often overlooked area in studies of the health care industry that more commonly center on patient–physician satisfaction. The current study's results provide suggestions for better hospital management and further insight into the challenges of improving physician satisfaction in the health care industry.

The medical consultation is one of the requirements in diseases diagnosis and patient treatment. In addition, a high-quality consultation is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to identify factors affecting the high-quality consultation in medical communications.

The following electronic databases were searched: MEDLINE (via PubMed), Web of Science, Cochrane, EMBASE, Scopus and ProQuest until December 2018. In addition, the authors searched Google Scholar. Qualitative and quantitative studies were assessed using the Critical Appraisal Skills Programme, Qualitative Checklist and the Center for Evidence-Based Management appraisal checklist, respectively. A stepwise approach was conducted for data synthesis.

Of 3,826 identified studies, 29 met the full inclusion criteria. Overall, after quality assessment of studies, 25 studies were included. The studies were conducted in the USA (n=6), the UK (n=6), the Netherlands (n=4), Canada (n=2), Belgium (n=2), Poland (n=2), Germany (n=1), Iran (n=1), Finland (n=1), Austria (n=1), Qatar (n=1), Denmark (n=1) and China (n=1), and five studies were excluded. Data synthesis showed that high-quality consultation consisted of three main categories: structural (4 main themes with 26 sub-themes), process (2 main themes with 33 sub-themes) and outcome (3 main themes with 12 sub-themes) quality.

Using the indicators of consultation quality improvement can develop physicians’ clinical competence and skills. Decision makers can use them to monitor and evaluate physicians’ performance. A high-quality consultation can be useful in social prescribing that helps patients to manage their disease.

Visit time is a crucial aspect of patient–physician interaction; its inadequacy can negatively impact the efficiency of treatment and diagnosis. In addition, visit time is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to determine factors influencing the consultation length of physicians and to compare consultation length in different countries.

MEDLINE (PubMed), Web of Science, Cochrane, ProQuest, Scopus, and Google Scholar were searched. In addition, references of references were checked, and publication lists of individual scholars in the field were examined. We used data sources up to June 2018, without language restriction. We used a random-effects model for the meta-analyses. Meta-analyses were conducted using Comprehensive Meta-Analysis Version (CMA) 3.0.

Of 16,911 identified studies, 189 studies were assessed of which 125 cases (67 percent) have been conducted in the USA. A total of 189 studies, 164 (86.77 percent) involved face-to face-consultations. The effects of three variables, physician gender, patient gender, and type of consultation were analyzed. According to moderate and strong evidence studies, no significant difference was found in the consultation lengths of female and male doctors (Q=42.72, df=8, I²=81.27, p=0.891) and patients’ gender (Q=55.98, df=11, I²=80.35, p=0.314). In addition, no significant difference was found in the telemedicine or face-to-face visits (Q=41.25, df=5, I²=87.88, p=0.170).

In this systematic review and meta-analysis, all of physicians’ visits in 34 countries were surveyed. The evidence suggests that specified variables do not influence the length of consultations. Good relationship is essential to a safe and high-quality consultation and referral process. A high-quality consultation can improve decisions and quality of visits, treatment effectiveness, efficiency of service, quality of care, patient safety and physician and patient satisfaction.

The physician–patient relationship is the cornerstone of care quality. Unfortunately, it may be adversely affected by physician burnout, which is becoming more prevalent according to the literature. We present a model, based on the burnout and physician–patient communication literatures, which delineates the impact of physician burnout on the physician–patient interaction and ultimately on patient outcomes. In short, when physicians use depersonalization to cope with emotional exhaustion, their communication style becomes more biomedically oriented. Faced with this communication style when interacting with their physician, patients are less satisfied, trusting, and adherent. The implications of this model and directions for future research are presented.

The purpose of this paper is to examine how patient assessment of primary care physician (PCP) communication is related to patient satisfaction with the PCP, patient perception of PCP professional competence, patient assessment of the relationship with the doctor and patient demographic characteristics using a segmentation approach.

The authors surveyed 514 adult patients waiting for appointments with their PCPs in two US primary care clinics. A latent class analysis was used to identify mutually exclusive unobserved homogeneous classes of patients.

The authors identified three distinct classes/groups with regard to patient assessment of physician communication and the physician-patient relationship. The largest group (53 percent of the sample) assessed their PCP communication and other doctor-patient relationship aspects as excellent. However, 37 percent provided mostly negative assessments, expressed high general dissatisfaction with the physician and disagreed with the statement that their PCP was well qualified to manage their health problems. These patients were on average more educated and affluent and the group included more males. About 10 percent of patients expressed generally lower satisfaction with the PCP, though their dissatisfaction was not as extreme as in the highly dissatisfied group.

Further studies are needed to help physicians develop skills to communicate with different patients.

Patient segmentation can be an important tool for healthcare quality improvement particularly for emerging approaches to primary care such as patient-centered care.

The purpose of this paper is to investigate the phenomenon of the digital do-it-yourself (DiDIY) in the medical domain. In particular, the main contribution of the paper is the analysis and discussion of a questionnaire-based user study focused on 3D printing (3DP) technology, which was conducted among clinicians of one of the most important research hospital group in Lombardy, Italy.

A general reflection on the notion of knowledge artifacts (KAs) and on the use of 3DP in medicine is followed by the research questions and by a more detailed analysis of the specialist literature on the usage of 3DP technology for diagnostic, training and surgical planning activities for clinicians and patients. The questionnaire-based user study design is then emerging from the conceptual framework for DiDIY in healthcare. To help focus on the main actors and assets composing the 3DP innovation roles in healthcare, the authors model: the DiDIY-er as the main initiator of the practice innovation; the available technology allowing the envisioning of new practices; the specific activities gaining benefits from the innovative techniques introduced; and the knowledge community continuously supporting and evolving knowledge practices.

The authors discuss the results of the user study in the light of the four main components of our DiDIY framework and on the notion of KA. There are differences between high expertise, or senior, medical doctors (MDs) and relatively lower expertise MDs, or younger MDs, regarding the willing to acquire 3DP competences; those who have seen other colleagues using 3DP are significantly more in favor of 3DP adoption in medical practices, and those who wish to acquire 3DP competence and do-by-themselves are significantly more interested in the making of custom-made patient-specific tools, such as cutting guides and templates; there are many recurrent themes regarding how 3DP usage and application may improve medical practice. In each of the free-text questions, there were comments regarding the impact of 3DP on medical knowledge practices, such as surgical rehearsal, surgery, pathology comprehension, patient-physician communication and teaching.

The 3DP adoption in healthcare is seen favorably and advocated by most of the respondents. In this domain, 3DP objects can be considered KAs legitimately. They can support knowledgeable practices, promote knowledge sharing and circulation in the healthcare community, as well as contribute to their improvement by the introduction of a new DiDIY mindset in the everyday work of MDs.