The response rate was 39% (n = 464) of about 1200 survey recipients. The radar plot in Fig. 1 shows the average score on the Likert scale (1–7) for the 20 items of the JSE-HP, broken down by subscale (PT, CP, and WPS) for groups of GPs with the highest empathy (dotted-line) and lowest empathy (black solid line) scores. The abbreviated JSE-HP items are reported under Fig. 1.
The high empathy GPs averaged 7 on all scale items except for CP12 and CP18. Low empathy GPs (solid line) scored lowest on items 1, 12, 17 and 18, and highest on CP19 and PT20. Thus, high empathy GPs scored relatively higher than low empathy GPs in PT subcomponents compared to CP. The scores of GPs in highest decile scores were largely consistent, while those in the lowest decile group were more varied across all subgroups as indicated by the CVs and CIs in Table 1 (available in the Supplementary Files). The items with the greatest difference between high and low empathy groups were CP1 and PT17. Both high empathy and low empathy GPs scored disproportionately low in CC12 “Life events in understanding physical complaints” which indicates that asking patients about what is happening in their personal lives is helpful in understanding their physical complaints.
Table 1 displays profiles of the group of GPs with the highest decile (90th percentile) and lowest decile (10th percentile). This includes descriptive statistics on the empathy score and its’ subcomponents, as well as personal and professional characteristics for the two groups. The mean empathy score of high empathy GPs (135) was 36 score points greater than the score of
99 for low empathy GPs (p < 0.001). The scores were significantly higher in the high empathy group across all three subscales.
Overall, the intra-group variation measured by the CVs and related 95% CIs was over three times higher among low empathy GPs, compared to high- empathy GPs for total score and among all subcomponents.
Among the personal characteristics the majority of the high empathy group was female (61.5%), whereas the majority of the low empathy group was male (67.4%) (p = 0.0076). There was no difference in age across high and low profiles. Of the professional characteristics, there were no differences between the two groups with respect to practice type, years since completion of GP training, and years in present practice. While the difference in overall job satisfaction between the groups was not statistically significant, there was a trend towards higher job satisfaction in the top decile with high empathy GP’s (p = 0.0825).
The GPs in the top decile placed significantly greater value on the contribution of the physician-patient relationship (6.69 vs. 5.59), intellectual stimulation (6.21 vs. 5.04) and interaction with colleagues (6.03 vs. 4.70) to their job satisfaction (all p < 0.0001). There was no intergroup difference with respect to the contribution of prestige and profit.
The variation index (VI), which reflects intergroup variation, was relatively high for gender, total empathy score and its subcomponents, overall job satisfaction, contribution to job satisfaction from the physician-patient relationship, intellectual stimulation and interaction with colleagues. In contrast, there was relatively low intergroup variation with respect to the GP’s age, practice type, experience, contribution to job satisfaction from economic profit and prestige. Overall, the VI and related 95% CIs were lower in GPs with the highest empathy than those with the lowest empathy across personal and professional GP characteristics. The antibiotic prescribing profiles are shown in Table 2 (available in the Supplementary Files).
Antibiotics prescribing profiles:
Overall, the high-empathy GPs made 19% fewer antibiotic prescriptions per year than the low empathy group (428 vs. 529 prescriptions).
Penicillins profiles:
The most frequently prescribed antibiotic was the group of penicillins (JO1C) which represents 64% (high empathy profile) and 69% (low empathy profile) of all types of antibiotics as shown in Table 2. High-empathy GPs made 92 fewer prescriptions among all types than the low-empathy GPs. Low empathy GPs also prescribe relatively more antibiotics in most penicillin subcategories, except for those Combinations with beta lactamase inhibitors (B) J01CR. For these categories the measured intergroup variation VI range in terms of the mean penicillin prescribing was between 0.70 and 0.84. The VI was highest for penicillins with extended spectrum (JO1CA) 0.79, (J01CR) 0.84 and lowest for beta-lactamase sensitivity and beta-lactamase resistant penicillins (J01CE & J01CF) 0.70–0.71 belonging to the group of narrow spectrum antibiotics. In addition, the test of differences shows a significant mean difference between groups for the narrow spectrum penicillins (J01CE & J01CF) and one of the two broad spectrum penicillins.
Non-penicillin profiles:
In most cases, this group of antibiotics are used after bacterial culture (and known resistance pattern) and thus based on a more precise and stringent diagnosis.
Table 2 shows that there were no differences in prescribing of non-penicillin antibiotics across the high versus low empathy groups.
Narrow versus broad spectrum:
Calculated size effects indicates that low empathy GPs both prescribed narrow and broad spectrum antibiotics more often but this trend was not significant (p < 0.05).