PONE-D-21-08356

Doctor-patient communication and trust in doctors during COVID 19 times – a cross sectional study in Chennai, India

PLOS ONE

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Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

Reviewer #7: Yes

Reviewer #8: Yes

Reviewer #9: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: I Don't Know

Reviewer #7: Yes

Reviewer #8: Yes

Reviewer #9: I Don't Know

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

Reviewer #7: Yes

Reviewer #8: Yes

Reviewer #9: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

Reviewer #7: No

Reviewer #8: Yes

Reviewer #9: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Good study. However the arrangements of sentences and paragraphs are not in sequential manner. The title and the content are not matching. As per the content more data regarding the doctor patient communication must have been analyzed.

Reviewer #2: The article investigated difficulties faced by patients in communicating with their doctors due to the COVID 19 preventive measures. This is an important issue. Although some issues found which need to be addressed prior to its publication.

1. Avoid using long sentences. This have caused grammatical errors and readability of the article.

2. Kindly use full form of abbreviations on first use.

3. Use MeSH terms as keywords.

4.In introduction every paragraph must have a theme. Paragraph 2 and 4 is very short. Club them with preceding paragraph. Arrange introduction as following: background characteristics, knowledge gaps exists, how your study is going to address those gaps. Cite important references used in discussion in introduction.

5. Avoid using terms like heart of the city. If your hospital were in heart were was the liver, kidneys and lungs????

6. If used a non-probabilistic sampling then why design effect was not used for sample size calculation.

7. Tables should be self-explanatory. Kindly write abbreviations used in the tables in the foot notes. Statistical analysis used in each table should either be used in title or footnotes. Indicate 'N' of each table.

8. If several prior studies were available on the issue. Then why they were not used in sample size calculation.

9. The article did not follow uniform referencing style. Kindly manually redo it as per the journals guidelines.

Reviewer #3: Doctor patient communication and trust is a complex process where social and emotional factors, empathy and attentive listening are important parameters, qualitative techniques may provide more information. I think it covers some points related to quality of care. Only a part of interaction was assessed without any comparison group. sampling technique is inappropriate and not representing the categories of morbidities.

Reviewer #4: Reviewer’s comment for the article entitled “Doctor-patient communication and trust in doctors during COVID 19 times – a cross sectional study in Chennai, India.”

The research question is quite interesting, innovative and satisfying the current need where continuous efforts are explored for doctor-patient communication and trust in pandemic situation. The article is well written and addressing major aspects in focus. The rationale for the proposed study seems clear and valid. The study has a clear methodology and interesting findings which would be positively utilized by the readers at different forums. Results can be understood simply and categorized properly. It includes relevant information. The data and analyses support the claims and findings. Discussion portion is clearly written. The authors are free to receive a suggestion to include recommendations to overcome limitations of the study which would be useful for future explorations by reader community. The study shows sufficient potential and up to the standards of the journal.

Reviewer #5: The paper is well written and covers a very relevant and important area during this pandemic. The analysis has been done reasonably well and results presented in an intelligible manner. The results are very pertinent to changing policies and behaviour.

Reviewer #6: This is a timely manuscript assessing the difficulties faced by patients in communicating with their doctors due to the COVID 19 preventive measures, and its impact on the trust on their doctors. The study was conducted during the peak of the pandemic in a large Indian metro city in a tertiary care hospital that caters to a specific group of patients. The participants were identified and recruited in four settings (in patients, OPD patients, Covid isolation facilities and the hospital waiting areas) and authors rightly explain the importance of settings where they were recruited in terms of severity and urgency of their symptoms.

The most intriguing finding of the study is that with increasing age there was increasing trust in the doctor but less difficulties in doctor-patient communication. One would expect otherwise especially the communication barrier increasing with increasing age of the patient. The authors elaborate on three possible reasons for this finding which are interesting and plausible in the context of Indian healthcare system. However, the fact that the communication with elderly patients might always have been challenging and therefore the elderly did not experience any added barriers in communicating with the doctors raises important questions regarding doctor patient communication during non-covid times. To what extent this finding could be also influenced by the fact that the elderly in particular felt grateful to be seen by someone in a health facility in these trying times when they might have tried hard to reach the hospital for several days? Could this sense of gratitude combined with high degree of respect towards doctors in general in Indian society at least in the minds of older patients influenced their perception of reduced communication barrier? This aspect can be explored further in the discussion section.

In follow-up of the point above, healthcare providers in PPE and masks during Covid 19 pandemic probably made it impossible for the patients to assess whether the particular HCW interacting with them is a doctor, a medical student and intern or a nurse. There is hierarchy among different health care professionals and patients also respect and trust these different groups of health care professionals differently. PPE and overalls in some ways homogenized all HCWs which can otherwise be easily stratified by patients based on the age, socio-economic status based on jewelry and clothing wore under the apron etc. I wonder what impact this phenomenon (of homogenization of HCWs in PPEs) could have had on patients’ level of trust in doctors. Could authors reflect on this aspect further and particularly its implications for doctor patient relationship in non-pandemic settings.

Women patients trusted doctors more than men. How can this be explained especially if it is not linked with education? Is it because women in general are less often in position of power or less likely to challenge the individuals with authority like doctors and therefore tend to put higher respect and trust in doctors?

I wonder whether the authors analyzed the responses in three domains in relation to the settings in which the participants were recruited in this study. How was the experience of those seen in outpatient department different than those who were admitted or were in isolation facility or were just in waiting areas? My suspicion is that the context in which they answered the questions combined with their symptoms and severity of those symptoms might pose different challenges in doctor patient communication and might also affect the level of trust they put in their healthcare providers. I would also expect difference in challenges encountered to access health services for participants in these four distinct settings, not just in terms of reaching the healthcare facility but also once they entered the facility while they were being triaged or diverted in different streams. Could authors elaborate on why they did not pursue this line of analysis?

Reviewer #7: Dear Authors,

The submitted manuscript, with its objectives is currently of utmost importance in the COVID era. This may help in formulating policies for future pandemics.

However, the following points need to be rectified in the manuscript

1. There are two objectives- first is to formulate a questionnaire using factor analysis and then execute the same. Hence, this needs to be clarified and subdivided in the paper

2. The flow of paper needs to be streamlined. The factor analysis to be explained first, then the execution of the study using this questionnaire.

3. Language and fluidity needs to be looked into.

4. Other comments have been made as track changes in the attached PDF.

Regards,

KS

Reviewer #8: The title of the study is more contemporary addressing the current issues that has struck the globe. There is an attempt with success to explore the outcomes from the COVID imposed behaviour which is also made mandatory by the Government and Statutes as 'Covid appropriate behaviour'.It is further appreciated that in a Metropolitan City of Southern India, the Covid appropriate behaviour from the part of the doctors and medical professionals had reduced the effective doctor-patient relationship. The authors could have explored the probable measures to overcome these obstacles, especially in a time when the globe is further being made to face the second wave ofthe pandemic.

Reviewer #9: The authors have used Cronbach’s Alpha coefficient for internal consistency of parameters. This is not a statistical method but I do not know details of how this method works. I also do not know varimax rotational method although the meaning of factor analysis to study relationship of factors is understood. Application of Bartlett's test of sphericity to test whether the authors' model is fit or not is also not understood by me.

I have attached my review comments. On the whole the paper appears to be fine and requires only minor corrections.

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Reviewer #1: No

Reviewer #2: Yes: Bijit Biswas

Reviewer #3: No

Reviewer #4: No

Reviewer #5: Yes: Aneesh Basheer

Reviewer #6: No

Reviewer #7: No

Reviewer #8: Yes: Dr. Arun M

Reviewer #9: No

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Attachments

Attachment

Submitted filename: PONE-D-21-08356_reviewer_19April.pdf

Doctor-patient communication and trust in doctors during COVID 19 times – a cross sectional study in Chennai, India

PONE-D-21-08356R1

Dear Dr. Gopichandran,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Prof. Ritesh G. Menezes, M.B.B.S., M.D., Diplomate N.B.

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #6: All comments have been addressed

Reviewer #7: All comments have been addressed

Reviewer #9: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #6: Yes

Reviewer #7: Yes

Reviewer #9: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #6: I Don't Know

Reviewer #7: Yes

Reviewer #9: (No Response)

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #6: No

Reviewer #7: Yes

Reviewer #9: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #6: Yes

Reviewer #7: Yes

Reviewer #9: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #6: (No Response)

Reviewer #7: (No Response)

Reviewer #9: (No Response)

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If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #6: Yes: Priya satalkar

Reviewer #7: No

Reviewer #9: No