The impact of doctor-patient communication on patient satisfaction in outpatient settings: implications for medical training and practice

Abstract

Poor doctor-patient communication significantly contributes to patient dissatisfaction. This study investigates the impact of doctor-patient communication quality on patient satisfaction to guide medical education, clinical training, and hospital management improvements. Using validated questionnaires, we found a significant positive correlation between overall communication quality and patient satisfaction (r = 0.539, p < 0.001). Specifically, dimensions of medical information communication (r = 0.530, p < 0.001) and communication skills (r = 0.417, p < 0.001) were significantly correlated with patient satisfaction, whereas cognitive and emotional communication dimensions were not significantly correlated. Regression analysis further demonstrated communication satisfaction as a reliable predictor of patient satisfaction (R² = 0.287, p < 0.001). We recommend enhancing healthcare providers’ communication skills and detailed medical information disclosure through targeted training programs. Emphasizing patient-centered communication strategies can substantially improve patient satisfaction and reduce doctor-patient disputes.

Introduction

In the treatment of patients, communication between doctors and patients plays a crucial role, alongside the technical skills of medical staff. Effective communication not only serves as an essential part of the medical process but also forms the foundation for establishing trust and rapport in the doctor-patient relationship. It allows physicians to obtain key diagnostic information, respond to emotional needs, and provide tailored medical education, ultimately promoting better health outcomes. Numerous clinical studies have demonstrated that effective communication enhances recovery, reduces anxiety, and contributes to patient safety, while poor communication is linked to patient dissatisfaction and increased medical disputes [1–5].

Doctor-patient communication, also known as physician-patient communication, refers to the exchange of information, feelings, and expectations between medical professionals and patients [6]. It includes not only discussions about diagnoses and treatments, but also the communication of risk, empathy, and shared decision-making. While previous research has broadly affirmed the importance of communication, few studies have quantitatively examined the contribution of distinct communication dimensions—such as medical information sharing and interpersonal communication skills—to overall patient satisfaction. This lack of granularity limits the development of targeted educational strategies and practical improvements.

There are two levels of doctor-patient communication to be distinguished. Narrowly defined, doctor-patient communication refers to the exchange of information between healthcare providers and patients or their families about injuries, illnesses, diagnoses, treatments, and related factors (such as costs and services), typically in a clinical setting. Broadly defined, doctor-patient communication includes interactions between various healthcare workers, administrators, medical educators, and policymakers. This broader communication encompasses discussions on healthcare policies, medical ethics, legal regulations, and healthcare standards [7]. It is also important to distinguish patient experience from patient satisfaction. Patient experience encompasses all interactions patients have with the healthcare system, including interpersonal, organizational, and systemic factors. In contrast, patient satisfaction focuses on whether the patient’s expectations have been met. The Beryl Institute, an internationally recognized organization in this field, defines patient experience as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care” [8]. Furthermore, the Institute emphasizes the need to support the “human experience”, which includes the experiences of both patients and healthcare providers, in order to build more resilient and empathic care environments [9].

Studies consistently show that the quality of doctor-patient communication correlates positively with patient satisfaction. Effective communication is an essential strategy for reducing and resolving conflicts, contributing to the creation of a harmonious doctor-patient relationship [10]. In response to these gaps, this study investigates how various dimensions of doctor-patient communication affect patient satisfaction in an outpatient setting. Using validated questionnaires, we aim to identify the specific aspects of communication that most significantly influence satisfaction. Our goal is to provide evidence-based recommendations for improving clinical practice, medical education, and hospital management—ultimately contributing to the cultivation of a more harmonious, patient-centered healthcare system.

Methods

Doctor-patient communication questionnaire

Based on the Roter Interaction Analysis System (RIAS) [11], we adapted the Doctor-Patient Communication Survey originally proposed by Chen Wenhui [12]. Before initiating the formal survey, we conducted a pilot test to ensure the clarity and feasibility of the items in this population. The final questionnaire consisted of six sections, using a 5-point Likert scale. For example, the item " Trust in the doctor " has five options: “1. Very distrusting, 2. Distrusting, 3. Neutral, 4. Trusting, 5. Very trusting.” The options are assigned values (1–5) to facilitate analysis based on scores for each dimension. The four main communication dimensions included: Cognitive Dimension, Medical Information Communication, Emotional Communication, and Communication Skills. Details are listed in Table 1.

Table 1.

Outpatient Doctor-Patient communication survey indicators

No.	Indicator Content
Cognitive Dimension	A1. Current doctor-patient relationship
	A2. Trust in the doctor
	A3. Impact of communication on doctor-patient relations
	A4. Role of the doctor and patient in communication
	A5. Relationship between poor communication and medical disputes
Medical Information Communication	B1. Inquiry about the patient’s condition
	B2. Disclosure of the disease diagnosis
	B3. Disclosure of required tests/treatments
	B4. Patient’s consent for proposed tests/treatments
	B5. Disclosure of medication side effects
	B6. Disclosure of treatment or examination costs
	B7. Disclosure of prognosis
	B8. Advice on health consultation or disease prevention
	B9. Information on follow-up or re-examination
	B10. Understanding of the patient’s social, work, or life situation
	B11. Clarity of outpatient medical records
	B12. Time spent on patient examination
	B13. Adequacy of time spent diagnosing the patient
Emotional Communication	C1. Greetings between doctor and patient
	C2. Doctor’s attitude
	C3. Anxiety, tension, or other emotional reactions experienced by patient
	C4. Patient sharing anxiety or tension with doctor
	C5. Doctor’s response to patient emotional disclosure
	C6. Doctor’s attentiveness during the interview
	C7. Emotional exchange in resolving conflicts and preventing medical disputes
Communication Skills	D1. Use of medical terminology by the doctor
	D2. Clarity of doctor’s language
	D3. Patience of the doctor
	D4. Doctor’s mental focus during the consultation
	D5. Interruptions during patient’s statement
	D6. Patient’s inquiries about unclear information
	D7. Doctor’s explanation of the patient’s inquiries
Other Communication Factors	E1. Interruptions during consultation
	E2. Evaluation of consultation environment
	E3. The degree of patients fully expressing themselves
	E4. Reasons for insufficient expression
Overall Evaluation of Communication	F1. Patient’s satisfaction with communication during the visit
	F2. Major factors influencing communication effectiveness

Outpatient patient satisfaction survey

On the basis of Patient Satisfaction Questionnaire (PSQ-III) [13], Internal Patient Satisfaction Questionnaire (IPSQ), the outpatient satisfaction survey was adapted from Li Lin’s design [14], including four main dimensions with 5–11 indicators each (Table 2). The 11-point Likert scale (with 10 indicating complete satisfaction and 0 indicating total dissatisfaction) provides a comprehensive way to assess patient experiences. Responses of “Not applicable” or “Unaware” are treated as missing data and assigned a score of 6.

Table 2.

Outpatient patient satisfaction survey indicators

No.	Indicator Content
Environment and Facilities	A1. Convenience of the visit
	A2. Clarity of directional signs
	A3. Waiting area environment
	A4. Environment of outpatient examination rooms
	A5. Professional appearance of medical staff
Support Services	A6. Service by guiding staff
	A7. Service by registration, billing staff
	A8. Triage nurses’ explanation of visit matters
	A9. Waiting order in the consultation room
	A10. Service by examination department staff (e.g., ultrasound, CT)
	A11. Service by injection room staff (e.g., injections, fluids, observation)
	A12. Service by pharmacy staff
	A13. Service related to wound care, outpatient surgery
	A14. Service by housekeeping, security, and elevator staff
Medical Process	A15. Waiting time for registration, payment
	A16. Waiting time for doctor consultation
	A17. Timeliness and convenience of receiving medications
	A18. Waiting time for examinations
	A19. Overall process of the hospital visit
Medical Quality	A20. Doctor’s attitude
	A21. Doctor’s professional competence
	A22. Doctor’s attentiveness and patience
	A23. Doctor’s respect and protection of patient privacy
	A24. Explanation of diagnosis and treatment options
	A25. Explanation of medication use and precautions
	A26. Doctor’s responses to patient inquiries
	A27. Doctor’s focus on patient safety
	A28. Transparency of medical costs
	A29. Professional ethics and integrity of the doctor
	A30. Overall satisfaction with outpatient services

Statistical analysis

Clinical trial number: not applicable. General descriptive analysis was performed on the sociodemographic data as well as the relevant contents of the survey questionnaire. Rank-sum test and chi-square test were conducted to identify differences. Multivariate analysis was applied to identify factors influencing doctor-patient communication, including methods such as factor analysis and logistic regression analysis. Internal reliability was measured using Cronbach’s alpha coefficient. A p-value of less than 0.05 was considered statistically significant. All analyses (except when noted) were performed using the Statistical Package for the Social Sciences (SPSS) version 22.0 (SPSS Inc., Chicago, IL, USA).

Results

Participants

A total of 114 questionnaires were distributed for this survey. To exclude responses that may have been filled out carelessly, questionnaires with a completion time of less than 250 s or over 1800 s were excluded, resulting in 101 valid responses. A post hoc power analysis using G*Power software indicated that with n = 101, the study achieved 92% power to detect a medium effect size (r = 0.4, α = 0.05, two-tailed), confirming the sample size’s adequacy for correlation analysis.

Demographic characteristics of the participants are summarized in Table 3. The sample predominantly comprised individuals aged 18–30 years (80.20%), with a slight male majority (57.43%). Most respondents were urban residents (92.08%), had attained a bachelor’s degree or above (86.14%), and were unmarried (76.24%). Regarding income, 65.34% of participants earned more than ¥2000 monthly. Most patients were covered by basic health insurance or a combination of basic and commercial insurance. The majority visited general outpatient clinics, with a broad distribution across medical specialties. This cohort reflects a typical urban, young outpatient demographic at tertiary hospitals in China and provides diversity in income, education, and clinical departments.

Table 3.

Demographic characteristics of participants

Category	Group	Number	Percentage
Medical Specialty	Respiratory	26	25.74%
	Endocrinology	10	9.90%
	Hematology	3	2.97%
	Gastroenterology	19	18.81%
	Rheumatology	1	0.99%
	Cardiovascular	4	3.96%
	Other	38	37.62%
Outpatient Category	Emergency	11	10.89%
	Specialist	27	26.73%
	General	63	62.38%
Gender	Male	58	57.43%
	Female	43	42.57%
Age	18–30 years	81	80.20%
	31–40 years	3	2.97%
	41–50 years	13	12.87%
	51 + years	4	3.96%
Marital Status	Unmarried	77	76.24%
	Married	24	23.76%
Education Level	High School or lower	6	5.94%
	College	8	7.92%
	Bachelor’s	85	84.16%
	Master’s or higher	2	1.98%
Occupation	Corporate Worker	6	5.94%
	Government Worker	9	8.91%
	Education, Healthcare, or Medical Personnel	12	11.88%
	Retired	2	1.98%
	Self-employed	3	2.97%
	Other	69	68.32%
Monthly Income	<¥1000	7	6.93%
	¥1000-¥1999	16	15.84%
	¥2000-¥4999	37	36.63%
	¥5000-¥9999	29	28.71%
	>¥10,000	12	11.88%
Payment Method	Basic Health Insurance	57	56.44%
	Basic Health + Commercial Insurance	34	33.66%
	Self Fund	6	5.94%
	Other	4	3.96%
Residence	Urban	93	92.08%
	Rural	8	7.92%

Reliability and validity analysis of doctor-patient communication questionnaire

Reliability Test showed that the doctor-patient communication questionnaire demonstrated high internal consistency, with an overall Cronbach’s α of 0.859. The α values for individual dimensions were as follows: cognitive (0.776), medical information communication (0.868), emotional communication (0.662), and communication skills (0.653), suggesting acceptable to excellent reliability.

The questionnaire on doctor-patient communication was divided into four dimensions: cognitive, medical information, emotional communication, and communication skills. The validity of each dimension was assessed within each dimension. Detailed correlation coefficients between individual item scores and each dimension scores are shown in Table 4. All items showed statistically significant positive correlations with their respective dimension totals (p < 0.001), with most correlation coefficients ranging between 0.4 and 0.85. These results confirm the scale’s structural integrity and applicability to outpatient populations.

Table 4.

Validity analysis of Doctor-Patient communication questionnaire within each dimension

Cognitive Dimension	R	Medical Information Communication	R	Emotional Communication	R	Communication Skills	R
A1. Current doctor-patient relationship	0.329	B1. Inquiry about the patient’s condition	0.445	C1. Greetings between doctor and patient	0.428	D1. Use of medical terminology by the doctor	0.407
A2. Trust in the doctor	0.577	B2. Disclosure of the disease diagnosis	0.493	C2. Doctor’s attitude	0.429	D2. Clarity of doctor’s language	0.682
A3. Impact of communication on doctor-patient relations	0.476	B3. Disclosure of required tests/treatments	0.526	C3. Anxiety, tension, or other emotional reactions experienced by patient	0.592	D3. Patience of the doctor	0.804
A4. Role of the doctor and patient in communication	0.424	B4. Patient’s consent for proposed tests/treatments	0.726	C4. Patient sharing anxiety or tension with doctor	0.849	D4. Doctor’s mental focus during the consultation	0.632
A5. Relationship between poor communication and medical disputes	0.492	B5. Disclosure of medication side effects	0.669	C5. Doctor’s response to patient emotional disclosure	0.839	D5. Interruptions during patient’s statement	0.739
		B6. Disclosure of treatment or examination costs	0.731	C6. Doctor’s attentiveness during the interview	0.448	D6. Patient’s inquiries about unclear information	0.735
		B7. Disclosure of prognosis	0.796	C7. Emotional exchange in resolving conflicts and preventing medical disputes	0.296	D7. Doctor’s explanation of the patient’s inquiries	0.697
		B8. Advice on health consultation or disease prevention	0.605
		B9. Information on follow-up or re-examination	0.646
		B10. Understanding of the patient’s social, work, or life situation	0.482
		B11. Clarity of outpatient medical records	0.551
		B12. Time spent on patient examination	0.68
		B13. Adequacy of time spent diagnosing the patient	0.694

Outpatient patient satisfaction questionnaire reliability and validity analysis

The outpatient satisfaction questionnaire also demonstrated excellent internal consistency, with an overall Cronbach’s α coefficient of 0.957. Dimension-specific α values were: environmental facilities (0.808), medical support services (0.888), medical process (0.902), and medical service quality (0.955), supporting the tool’s robust reliability.

Validity analysis revealed strong correlations between individual item scores and dimension totals across all four domains. All the correlation coefficients are higher than 0.546, most of them are over 0.8 (p < 0.001)). Detailed correlation coefficients between individual item scores and each dimension scores are shown in Table 5. These findings validate the tool’s capacity to accurately assess outpatient satisfaction.

Table 5.

Validity analysis of outpatient patient satisfaction questionnaire within each dimension

Environmental facilities	R	Medical support services	R	Medical process	R	Medical service quality	R
A1. Convenience of the visit	0.737	A6. Service by guiding staff	0.546	A15. Waiting time for registration, payment	0.933	A20. Doctor’s attitude	0.924
A2. Clarity of directional signs	0.789	A7. Service by registration, billing staff	0.707	A16. Waiting time for doctor consultation	0.877	A21. Doctor professional competence	0.836
A3. Waiting area environment	0.829	A8. Triage nurses’ explanation of visit matters	0.673	A17. Timeliness and convenience of receiving medications	0.888	A22. Doctor’s attentiveness and patience	0.919
A4. Environment of outpatient examination rooms	0.832	A9. Waiting order in the consultation room	0.597	A18. Waiting time for examinations	0.933	A23. Doctor’s respect and protection of patient privacy	0.920
A5. Professional appearance of medical staff	0.784	A10. Service by examination department staff (e.g., ultrasound, CT)	0.639	A19. Overall process of the hospital visit	0.820	A24. Explanation of diagnosis and treatment options	0.888
		A11. Service by injection room staff (e.g., injections, fluids, observation)	0.794	A15. Waiting time for registration, payment	0.933	A25. Explanation of medication use and precautions	0.901
		A12. Service by pharmacy staff	0.857	A16. Waiting time for doctor consultation	0.877	A26. Doctor’s responses to patient inquiries	0.898
		A13. Service related to wound care, outpatient surgery	0.876			A27. Doctor’s focus on patient safety	0.930
		A14. Service by housekeeping, security, and elevator staff	0.704			A28. Transparency of medical costs	0.819
						A29. Professional ethics and integrity of the doctor	0.833
						A30. Overall satisfaction with outpatient services	0.919

Doctor-patient communication status

The results show that patient satisfaction with doctor-patient communication tends toward a moderate positive preference (Table 6). Among the four dimensions, communication cognition and communication skills scored higher, while medical information communication and emotional communication showed moderate scores. The overall communication satisfaction mean was 3.44 out of 5 (SD = 0.65), indicating a moderate positive patient perception. However, the relatively lower scores in the medical information and emotional dimensions suggest areas for improvement, particularly in information disclosure and empathy expression during consultations.

Table 6.

Scores for the four dimensions of Doctor-Patient communication

Dimension	Mean	Standard Deviation	Max	Min	Full Score
Communication Cognition	16.49	1.73	20	12	25
Medical Information	34.98	8.62	54	17	65
Emotional Communication	18.25	4.85	33	9	35
Communication Skills	21.76	3.62	30	13	35
Communication Satisfaction	3.44	0.65	5	2	5

Patient satisfaction scores

Patient satisfaction was assessed across four dimensions (Table 7). The highest scores were observed in the medical service quality dimension (M = 83.89, SD = 18.47), followed by medical support services (M = 67.24), environmental facilities (M = 39.19), and medical process (M = 34.97). The total satisfaction score had a mean of 225.73 out of 330 (SD = 41.29), indicating an overall high level of satisfaction with outpatient services. These findings suggest that while patients are generally satisfied with core medical services and facility environments, there is room for optimization in process efficiency and support services.

Table 7.

Outpatient patient satisfaction scores

Dimension	Mean	Standard Deviation	Max	Min	Full Score
Environmental Facilities	39.19	7.95	55	15	55
Medical Support Services	67.24	12.47	95	25	99
Medical Process	34.97	10.16	55	10	55
Medical Service Quality	83.89	18.47	121	11	121
Total Patient Satisfaction	225.73	41.29	316	131	330

Association between communication and satisfaction

Correlation and regression analysis

A correlation analysis between doctor-patient communication scores and overall patient satisfaction revealed a significant positive correlation (r = 0.539, p < 0.01). This indicates that the quality of doctor-patient communication is significantly correlated with overall patient satisfaction.

Regression analysis was performed with communication satisfaction as the independent variable and overall patient satisfaction as the dependent variable. The results show an R² of 0.287, with F(1,99) = 39.78, p < 0.01. This suggests a statistically significant linear relationship between communication satisfaction and patient satisfaction, with communication satisfaction explaining 0.287 of the variation in overall patient satisfaction. While statistically significant, this moderate correlation suggests that communication satisfaction is an important, but not exclusive, determinant of overall satisfaction.

Correlation of four communication dimensions with satisfaction

All four communication dimensions show a positive correlation with communication satisfaction, with significant correlations observed for communication cognition, medical information communication, and communication skills (Table 8). However, the correlation between emotional communication and communication satisfaction is not significant. The correlation coefficients for medical information communication and communication skills with communication satisfaction are both above 0.6, indicating a strong positive relationship. This suggests that communication satisfaction is most influenced by these two dimensions. Additionally, communication cognition is weakly positively correlated with communication satisfaction, implying that patients prioritize medical information communication and communication skills. While medical information communication and communication skills show a significant moderate correlation with overall patient satisfaction, communication cognition and emotional communication are not significantly related to overall satisfaction. These findings indicate that patients value clarity, responsiveness, and information adequacy more than affective communication in outpatient settings.

Table 8.

Correlation analysis of the four communication dimensions with communication satisfaction and overall satisfaction

Dimension	Communication Satisfaction (P)	Overall Satisfaction (P)
Communication Cognition	0.281 (0.004*)	0.115 (0.251)
Medical Information	0.656 (<0.001*)	0.530 (<0.001*)
Emotional Communication	0.172 (0.085)	0.130 (0.196)
Communication Skills	0.661 (<0.001*)	0.417 (<0.001*)

Regression analysis of communication dimensions

To gain a more comprehensive understanding of the factors affecting patient satisfaction and their impact, single-factor and multi-factor regression analyses were conducted. The goal was to identify the most significant, practical, and effective factors that could guide improvements in doctor-patient communication.

Satisfaction was used as the dependent variable, while scores for the four communication dimensions (communication cognition, medical information communication, emotional communication, and communication skills) served as independent variables. Single-factor regression analysis was conducted first, followed by multi-factor analysis to build a regression equation and identify factors influencing patient satisfaction (Table 9).

Table 9.

Single-Factor regression analysis of the four communication dimensions on overall satisfaction

Dimension	R²	F	P
Communication Cognition	0.011	1.056	0.307
Medical Information	0.304	43.237	<0.001*
Emotional Communication	0.023	2.333	0.130
Communication Skills	0.176	21.150	<0.001*

Regression analysis showed that medical information communication and communication skills are statistically significant predictors of overall patient satisfaction (p < 0.01). Specifically, the medical information communication dimension had a strong effect (R² = 0.304, p < 0.001), whereas emotional communication and communication cognition had minimal predictive power (p > 0.05). These results indicate that the medical information communication dimension is of primary importance in determining patient satisfaction.

Normality testing of satisfaction scores revealed a near-normal distribution (Skewness = -0.158, Kurtosis = -0.505), allowing for regression model validity. Multivariate or binary regression models combining dimensions did not significantly improve explanatory power (p > 0.05), indicating the sufficiency of individual predictors.

These results support the prioritization of enhancing information delivery and communicative clarity to effectively improve patient satisfaction in outpatient care.

Discussion

Summary of key findings and novel contributions

This study confirms the significant influence of doctor-patient communication quality on patient satisfaction. There is a significant positive correlation between the quality of doctor-patient communication and overall patient satisfaction. This suggests that communication satisfaction can serve as an important indicator of overall patient satisfaction [1, 15]. Notably, among the four communication dimensions, medical information exchange and communication skills demonstrated the strongest predictive power for overall patient satisfaction. While previous studies have emphasized the general importance of communication, our study offers a contribution by quantitatively evaluating the impact of discrete communication dimensions using regression modeling [16, 17]. This dimensional analysis allows for targeted recommendations on communication training and system improvement.

Communication practice in the clinical setting

Doctor-patient relationships, like other service-oriented interpersonal relationships, should be based on equality. However, due to the high technical nature of medicine, doctors are typically the decision-makers in treatment plans, and patients, because of their limited medical knowledge and their role as recipients of care, often assume a passive role. This inherent imbalance in the doctor-patient relationship makes it essential for doctors to take on more responsibility in guiding the patient through the communication process [18].

According to the survey, 77.97% of patients believed that doctor-patient communication plays a significant or very significant role in the doctor-patient relationship. This contrasts with the views presented in some studies who argue that the lack of mutual understanding between doctors and patients is a major cause of poor communication [19, 20]. Improving doctor-patient communication requires not only increasing doctors’ awareness of communication but also addressing other underlying issues to achieve significant improvements. This highlights the importance of improving communication awareness among both doctors and patients [2].

The role of medical information communication

Medical information communication emerged as the strongest predictor of satisfaction. This aligns with prior research indicating that patients prioritize clarity about diagnosis, treatment, medication, and prognosis above other relational factors. Communication quality is determined by the differences between the information provided by the source and the interpretation of the information by the recipient. A discrepancy in understanding can impair communication. A survey conducted revealed that while over 80% of doctors and patients agreed that patients or their families should inquire about the disease, causes, and treatment options, only 55% of patients reported receiving answers to these inquiries. Furthermore, 41.8% of patients did not understand the purpose of medical tests, and 21.2% were unclear about their medical conditions. Social psychology suggests that communication is more difficult when there is a lack of shared experience between communicators. Given the imbalance in medical knowledge between doctors and patients, communication barriers often arise [3, 21, 22]. Importantly, while empathy and emotional connection are valued, the cognitive domain appears to carry more weight in outpatient settings where time is constrained and informational exchange dominates the interaction.

Emotional communication and patient engagement

Although emotional communication was positively perceived in general, the study revealed significant deficiencies in emotional responsiveness. For example, greetings between doctors and patients, which are the first step in establishing respectful communication, were absent in 20.34% of doctor-patient encounters, and in approximately 22.88% of cases, one party greeted the other, but the greeting was not reciprocated. Regardless of the reasons, this lack of basic interaction is detrimental to the communication process.

In terms of encouragement, one-third of patients did not express feelings of anxiety or nervousness to their doctors. Among those who did share their feelings, only 58.33% reported that doctors offered only simple reassurance, which was not particularly effective. Additionally, around 8.33% of patients reported that doctors did not respond at all, which can have a significant psychological impact on patients. Emotional communication between doctors and patients is a crucial but often overlooked issue [23].

Emotional support can influence treatment adherence, and its underuse reflects a missed opportunity in brief consultations. These findings mirror global observations where high outpatient volume often diminishes emotional presence.

Application of communication skills

The term “skills” is often misunderstood. It is sometimes seen as insincere or pretentious, with some believing that “emotions outweigh skills” and that simply having genuine intentions is enough. However, this is not the case. Communication skills are an essential manifestation of communication ability. Even when doctors are sincerely passionate about serving patients, poor communication can still lead to misunderstandings or conflicts. Proper use of communication skills can enhance the effectiveness of interaction, preventing misunderstandings and improving the outcome of patient care [24].

This study shows that doctors in the hospital’s outpatient department generally apply communication skills well. Repetition of patient narratives by doctors served both as validation and rapport-building mechanisms. However, patients frequently reported a lack of clear explanations or full engagement when discussing diagnoses or treatment plans. For instance, nearly 90% of patients reported that doctors’ language was easy to understand, and 87.29% felt that doctors were patient during consultations, paying close attention when patients presented their medical histories. Additionally, when patients asked questions about unclear information, over 90% of doctors provided an explanation, although only about 20% of these explanations were detailed. Although most doctors demonstrated patience and clarity, “physician listening” remains under-addressed. Over 56.78% of patients reported that their statements were not interrupted, allowing them to express themselves fully. While interruption rates were recorded, the quality of listening—including feedback, clarification, and empathetic acknowledgment—was inconsistently experienced. Active listening, a core component of patient-centered communication, should be explicitly cultivated during clinical training.

This suggests that while the use of communication skills is generally good, there is still significant room for improvement, especially in providing more detailed explanations. Given the large volume of patients in the hospital, even minor deficiencies in communication can result in a large number of dissatisfied patients. Improving communication skills should be a priority to ensure more comprehensive patient care [24, 25].

Study limitations

Several limitations must be acknowledged. While this study focuses on face-to-face doctor-patient interactions, it is necessary to acknowledge that modern clinical communication increasingly incorporates digital tools—e.g., telemedicine, electronic health records, and messaging systems [26, 27]. Our methodology did not encompass such modes, which may limit the generalizability of findings to virtual environments. Future research should assess whether communication quality translates similarly across digital platforms. And reliance on patient-reported outcomes may introduce recall or social desirability bias. Surveys completed in less than 250s or over 1800s were excluded, which may introduce selection bias, albeit necessary to ensure response validity. Otherwise, although demographically diverse, the study was conducted at a single urban hospital, potentially limiting generalizability.

Implications for medical education and physician training

Our findings have direct implications for curriculum development in both undergraduate and continuing medical education. Specific training modules should address: Medical information delivery strategies (e.g., visual aids, lay language), listening techniques and verbal feedback [24], structured informed consent discussions [28], emotional support in high-pressure outpatient contexts [29]. Simulation-based training, role-play, and feedback loops can reinforce these skills. The communication dimensions identified in this study can serve as structural anchors for such educational frameworks.

Conclusion

This study confirms that the quality of doctor-patient communication significantly influences overall patient satisfaction. Among the four evaluated dimensions, medical information communication and communication skills emerged as the most impactful predictors of satisfaction, highlighting the need to improve informational clarity and interactive behavior in clinical encounters. While emotional communication and communication cognition were less predictive, they remain important for delivering patient-centered care.

Both the Outpatient Doctor-Patient Communication Questionnaire and the Outpatient Patient Satisfaction Questionnaire demonstrated strong reliability and validity, supporting their use in future clinical communication assessments.

We recommend that communication training in clinical education and hospital management prioritize clear information delivery and communication skills to foster safer, more empathetic, and satisfaction-oriented medical care.

Abbreviations

RIAS

Roter interaction analysis system

PSQ-III

Patient Satisfaction Questionnaire

IPSQ

Internal Patient Satisfaction Questionnaire

SPSS

Statistical Package for the Social Sciences

Author contributions

C.X, L.C, Y.P designed the work, acquired data; W.H and X.J collected questionnaire; L.C analysed data; C.X, and Y.P interpreted data; C.X, L.C, Y.P drafted the work; W.H, X.J, Y.K revised.

Funding

This study was supported by National Natural Science Foundation of China (No. 82401228, 82401227), Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (2022RC031) and Zhejiang Provincial Natural Science Foundation of China (LQ23H120005).

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with the principles of the Helsinki Declaration. According to Term 32 of China’s Ethical Review Measures for Life Science and Medical Research Involving Human (2023-4), ethical approval of this study was not required since it targeted research that does not cause harm to the human body, does not involve sensitive personal information or commercial interests, and uses anonymous information data for research. Participants were informed that their participation was voluntary, and informed consent was obtained from all participants. The study did not involve the processing of any sensitive personal data. Clinical trial number: not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.