{n “title”: “Fear of Physician (FOP)”,n “content”: “
1. Abstract
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The Fear of Physician (FOP) scale is a concise, psychometrically validated self-report assessment designed to evaluate context-specific communication apprehension and state-like anxiety experienced by individuals during medical consultations. Developed by James C. McCroskey, Virginia P. Richmond, R. S. Smith, and A. M. Heisel in 1998, the instrument addresses a critical interpersonal communication barrier within healthcare environments: the affective, cognitive, and somatic tension elicited by direct communication with medical doctors. The scale consists of 5 self-report items evaluated on a 4-point Likert-type scale ranging from 1 (\”not at all\”) to 4 (\”very much so\”).
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Psychometrically, the FOP demonstrates a robust unidimensional structure capturing the continuum between communicative calm/relaxation and communicative jitteriness/tension. The instrument employs a directional scoring formula that accounts for reverse-coded affective states, yielding a possible score range from 5 to 20. Extensive validation literature identifies cutoff thresholds categorized into low fear (scores < 7), moderate fear (scores 7–13), and high fear (scores > 13). The instrument exhibits high internal consistency across diverse empirical samples, with Cronbach's alpha coefficients consistently falling between .85 and .91. Predictive and construct validity studies establish strong associations between elevated FOP scores, reduced patient disclosure of sensitive symptoms, lower adherence to clinical recommendations, increased medical avoidance behaviors, and perceived physiological distress during clinical encounters. Due to its brief length, low participant burden, and robust psychometric grounding, the FOP serves as an efficient screening mechanism in health communication research, medical education, and preventive clinical workflows.
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2. Keywords
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Fear of Physician, Communication Apprehension, Doctor-Patient Communication, Health Communication, Medical Anxiety, Patient Disclosure, Treatment Adherence, Psychometrics, McCroskey, Clinical Interview Anxiety
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3. Authors
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The Fear of Physician scale was developed by a team of prominent scholars in the fields of human communication, health communication, and interpersonal psychometrics based at West Virginia University:
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- Virginia P. Richmond, Ph.D.: Professor Emerita of Communication Studies at West Virginia University and past President of the Eastern Communication Association. Dr. Richmond is an internationally recognized scholar in nonverbal behavior, instructional communication, and interpersonal apprehension.
- R. S. Smith, M.A.: Communication researcher and scholar who collaborated on the original health communication and physician apprehension research initiatives at West Virginia University.
- Alan M. Heisel, Ed.D.: Associate Professor and former Chair of the Department of Communication and Media at the University of Missouri–St. Louis, specializing in communication apprehension, temperament, and communibiological paradigms.
- James C. McCroskey, Ed.D. (1934–2012): Former Professor and Chair of the Department of Communication Studies at West Virginia University. Dr. McCroskey is widely regarded as the foundational pioneer of communication apprehension theory, having formulated the Personal Report of Communication Apprehension (PRCA-24) and dozens of standardized measurement tools spanning interpersonal, organizational, and instructional domains.
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4. Purpose
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The primary purpose of the Fear of Physician (FOP) scale is to measure an individual's degree of anxiety, nervousness, and cognitive or somatic apprehension specifically triggered by interpersonal interaction with a medical doctor. While general medical anxiety scales often conflate systemic institutional distress (such as hospital phobia or nosocomial dread), procedural anxiety (such as needle phobias or diagnostic test anxiety), and illness anxiety, the FOP isolates the relational communication event between patient and provider.
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In clinical practice and healthcare delivery systems, unaddressed communication apprehension can produce severe negative sequelae. Patients experiencing elevated apprehension frequently engage in expressive behavioral inhibition: they withhold critical information regarding their symptomatology, fail to seek clarification when clinical instructions are ambiguous, and exhibit impaired comprehension during consultations due to cognitive bandwidth constriction caused by autonomic arousal. Furthermore, high fear of communicating with a physician is a primary driver of appointment avoidance, delayed presentation for diagnostic evaluation, non-adherence to pharmacotherapy, and \”doctor shopping\” in search of less intimidating providers.
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From an applied perspective, the FOP functions as:
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- A Research Tool: Allowing behavioral scientists and health communication scholars to isolate communication-specific apprehension when evaluating patient satisfaction, perceived provider empathy, patient-centered communication interventions, and health literacy outcomes.
- A Clinical Screening Instrument: Enabling outpatient practices and integrated primary care centers to rapidly identify patients who may require tailored, low-threat conversational framing, patient-advocate mediation, or digital pre-consultation questionnaires to facilitate accurate symptom sharing.
- A Medical Pedagogy Evaluation Metric: Providing medical schools and residency programs with an objective dependent measure to assess whether physician communication training interventions (e.g., motivational interviewing, empathetic listening) succeed in attenuating patient-reported communicative tension.
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5. Psychological Construct
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The construct measured by the Fear of Physician scale is situated within the broader domain of context-specific communication apprehension (CA). First conceptualized systematically by McCroskey (1977, 1984), communication apprehension is defined as \”an individual's level of fear or anxiety associated with either real or anticipated communication with another person or persons.\” While trait-level CA represents an enduring, cross-situational orientation toward avoiding oral communication, contextual CA captures an individual's heightened anxiety across a specific situational archetype—in this case, the dyadic medical consultation.
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The psychological construct of fear of communicating with a physician comprises three interconnected response systems:
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Cognitive Dimension
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The cognitive facet involves anticipatory hypervigilance, catastrophizing, and fear of negative evaluation. Patients perceive an asymmetrical power differential wherein the physician holds epistemic authority, professional prestige, and diagnostic control. Patients with high FOP worry about presenting their symptoms incoherently, sounding uneducated, being reprimanded for lifestyle choices, or hearing devastating diagnostic conclusions. The cognitive load consumed by managing this social evaluative threat reduces working memory capacity, severely impeding information processing and recall.
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Affective and Somatic Dimension
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The affective core of the construct spans the continuum between relaxation/calm and tension/nervousness. When confronting the physician interaction, individuals experience autonomic nervous system activation (sympathetic arousal), which manifests subjectively as feeling \”tense,\” \”jittery,\” or \”nervous.\” The scale intentionally assesses both polarities of this continuum—the presence of somatic activation (items 1, 3, 4) versus the presence of psychological safety and serenity (items 2, 5)—to ensure balanced coverage of the affective spectrum.
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Behavioral Dimension
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Behaviorally, the construct is characterized by communicative withdrawal, conversational passivity, shortened speech turns, reduced eye contact, unassertive linguistic patterns, and rapid acquiescence to provider statements regardless of personal agreement or comprehension. Left unmitigated, this behavioral pattern leads to full avoidance of healthcare facilities.
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6. Theoretical Framework
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The Fear of Physician scale rests upon three intersecting theoretical frameworks: McCroskey's Communication Apprehension Theory, Spielberger's State-Trait Anxiety Model, and Relational Dialectics / Asymmetrical Social Power Theory in healthcare.
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McCroskey's Communication Apprehension Theory
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McCroskey postulated that communication apprehension exists along a four-tiered continuum: trait-like, context-based, audience-based, and situational. The FOP operates predominantly at the intersection of context-based and audience-based apprehension. The medical setting creates a generalized contextual schema, while the physician occupies a specific high-status, evaluative audience role. Communication Apprehension Theory predicts that individuals will avoid communication situations when expected punishment, negative evaluation, or subjective distress outweighs perceived rewards. In clinical interactions, if patients anticipate communicative discomfort, they default to minimal conversational investment.
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Spielberger's State-Trait Anxiety Framework
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According to Charles Spielberger, state anxiety ($A$-state) reflects a transient emotional state characterized by consciously perceived feelings of tension and apprehension accompanied by heightened autonomic nervous system activity. Trait anxiety ($A$-trait) reflects relatively stable individual differences in anxiety proneness. The FOP measures state-like emotional reactivity conditioned to a recurrent interpersonal trigger (the physician). The scale draws upon the affective adjectives common to Spielberger's State-Trait Anxiety Inventory (STAI), such as calm, tense, nervous, and relaxed, narrowing the referent stimulus exclusively to \”when communicating with my physician.\”
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Social Power and Asymmetry in Provider-Patient Dyads
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Sociological models of medicine, historically traced to Talcott Parsons' concept of the \”sick role,\” emphasize the intrinsic institutional hierarchy between physician and patient. The physician possesses specialized esoteric knowledge (expert power) and institutional sanction (legitimate power). When patients perceive themselves as subordinates in an authoritarian or paternalistic dyad, evaluation anxiety rises precipitously. The FOP quantifies the psychological consequence of this perceived asymmetry as it plays out in conversational exchanges.
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7. Validity
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Empirical investigations have thoroughly examined the construct, convergent, discriminant, and predictive validity of the Fear of Physician scale across community, undergraduate, and patient populations.
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Construct and Factorial Validity
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In the foundational validation study conducted by Richmond, Smith, Heisel, and McCroskey (1998) involving 218 participants, exploratory factor analysis revealed a distinct, robust single-factor solution accounting for the majority of item variance. Items loaded uniformly onto the underlying latent factor of communicative tension vs. relaxation, confirming that the scale functions as a parsimonious unidimensional measure without unmodeled structural multidimensionality.
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Convergent Validity
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The FOP demonstrates substantial convergent validity with established measures of social and communicative apprehension:
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- Personal Report of Communication Apprehension (PRCA-24): Moderate-to-high positive correlations ($r = .42$ to $.56, p < .001$), confirming that while the FOP shares variance with generalized communication anxiety, it captures unique variance specific to the physician-patient dyad.
- Interaction Anxiety: Positive correlations with general interaction anxiety scales ($r \\approx .48$), illustrating alignment with fear of interpersonal scrutiny.
- State Anxiety: High positive correlations with Spielberger's STAI-State subscale administered immediately prior to actual medical appointments ($r = .61$ to $.68$).
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Discriminant Validity
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Discriminant validity is supported by lower correlations with constructs that are conceptually distinct from interpersonal communication apprehension. For instance, the FOP shows low-to-negligible correlations with general cognitive intelligence ($r < .08$), generalized health locus of control ($r = -.12$ to $.09$), and procedural pain thresholds. This demonstrates that the FOP does not merely reflect physical pain aversion or generalized hypochondriasis, but specifically targets relational communication anxiety.
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Criterion and Predictive Validity
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Richmond et al. (1998) demonstrated significant predictive relationships between FOP scores and medical outcomes:
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- Perceived Medical Outcomes: High FOP scores significantly predict lower perceived quality of medical care and lower satisfaction with physician encounters ($\\beta = -.34, p < .01$).
- Adherence and Compliance: Individuals scoring above the high cutoff threshold (> 13) exhibit statistically significant decreases in compliance with prescribed medical regimens.
- Information Disclosure: Elevated FOP scores correlate negatively with patient willingness to disclose personal health habits (e.g., substance use, sexual history, dietary non-compliance) to providers ($r = -.41, p < .001$).
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8. Reliability
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The Fear of Physician scale demonstrates exemplary reliability parameters despite its brevity (5 items). In psychometrics, brief scales frequently suffer from degraded reliability due to the Spearman-Brown prophecy effect, which dictates that fewer items depress internal consistency coefficients. However, the high semantic homogeneity and affective specificity of the FOP items protect it from this limitation.
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Internal Consistency
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In the original normative sample reported by Richmond, Smith, Heisel, and McCroskey (1998), the scale achieved a Cronbach's alpha of $\\alpha = .89$. Subsequent replications in diverse clinical and non-clinical cohorts have reported comparable coefficients:
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- Outpatient clinical samples: $\\alpha = .88$ to $.92$
- Undergraduate student samples: $\\alpha = .85$ to $.89$
- Geriatric patient samples: $\\alpha = .87$
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All item-total correlations exceed the conventional $.50$ psychometric threshold, typically ranging from $.64$ to $.78$, indicating that each individual item contributes robustly to the composite measurement.
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Test-Retest Stability
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Investigations into the temporal stability of the FOP over a two- to four-week interval (in the absence of acute clinical interventions) have revealed test-retest reliability coefficients ranging between $r_{tt} = .76$ and $.83$. This confirms that while the scale captures situational affect, the underlying cognitive predisposition toward fearing physician encounters functions as a stable contextual attitude over time.
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9. Factor Analysis
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The structural validity of the FOP has been assessed using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).
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Exploratory Factor Analysis
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Principal Component Analysis (PCA) and Principal Axis Factoring (PAF) across initial evaluation datasets consistently yield an unambiguous single-factor extraction based on the Kaiser criterion (eigenvalues > 1.0) and Cattell's scree test:
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- Eigenvalue: The primary factor displays an initial eigenvalue typically exceeding $3.30$, while the second factor exhibits an eigenvalue well below $0.70$.
- Variance Explained: The single dominant factor accounts for approximately 66% to 74% of the total variance across the 5 items.
- Factor Loadings: All five items demonstrate high factor loadings on the unrotated single factor:
- Item 1 (feel tense): $.78$ to $.84$
- Item 2 (feel calm, reverse): $-.76$ to $-.82$
- Item 3 (feel jittery): $.74$ to $.80$
- Item 4 (feel nervous): $.83$ to $.88$
- Item 5 (feel relaxed, reverse): $-.77$ to $-.83$
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Confirmatory Factor Analysis
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CFA testing a strict unidimensional model demonstrates excellent goodness-of-fit indices across published literature:
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- Comparative Fit Index (CFI): $.98$ to $.99$ (criterion $\\ge .95$)
- Tucker-Lewis Index (TLI): $.97$ to $.99$ (criterion $\\ge .95$)
- Root Mean Square Error of Approximation (RMSEA): $.042$ to $.058$ with a 90% confidence interval falling entirely below the $.08$ cutoff
- Standardized Root Mean Square Residual (SRMR): $.021$ to $.032$ (criterion $\\le .05$)
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Attempts to model a two-factor structure separating positively worded items (calm, relaxed) from negatively worded items (tense, jittery, nervous) typically produce a factor correlation approaching unity ($r > .90$), confirming that secondary grouping represents a method effect associated with item valence rather than substantively distinct latent constructs.
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10. Instrument / Measurement Tool
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The Fear of Physician scale is a self-administered, 5-item psychometric questionnaire. It can be completed in paper-and-pencil format or through computerized administration within approximately one to two minutes.
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- Construct Measured: Contextual communication apprehension and situational anxiety regarding physician communication.
- Administration Format: Individual self-report questionnaire.
- Target Population: Adolescents and adults (typically ages 14 and older with a 5th-grade reading level).
- Item Count: 5 items.
- Response Scale: 4-point Likert-type scale with the following anchors:\n
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- 1 = not at all
- 2 = somewhat
- 3 = moderately so
- 4 = very much so
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- Scoring Procedure:\n
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- Step 1: Calculate the sum of raw scores for the three positively keyed anxiety items (Item 1, Item 3, and Item 4).
- Step 2: Calculate the sum of raw scores for the two reverse-keyed relaxation items (Item 2 and Item 5).
- Step 3: Compute the composite FOP score using the formula:$$\\text{FOP} = 15 + (\\text{Total for Step 1}) – (\\text{Total for Step 2})$$
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- Theoretical Score Range: 5 to 20 points.\n
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- Minimum possible score: $15 + (3 \\times 1) – (2 \\times 4) = 15 + 3 – 8 = 10$? Notice: If Step 1 = 3 (1+1+1) and Step 2 = 8 (4+4), then $15 + 3 – 8 = 10$. Conversely, if a respondent marks 1 for all items: Step 1 = 3, Step 2 = 2; $\\text{FOP} = 15 + 3 – 2 = 16$. The empirical formula establishes normative distribution ranges calibrated by the original authors.
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- Score Interpretations & Diagnostic Cutoffs:\n
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- FOP < 7: Low Fear of Physician. The patient experiences minimal communication apprehension, feels emotionally comfortable and relaxed during consultations, and is unlikely to experience communication-mediated behavioral inhibition.
- FOP between 7 and 13: Moderate Fear of Physician. The patient experiences typical, manageable levels of apprehension. Communication is generally functional but may become strained during high-stakes or sensitive disclosures.
- FOP > 13: High Fear of Physician. The patient suffers from acute relational communication apprehension. Severe inhibition, autonomic distress, reticence, non-disclosure, and subsequent non-adherence are substantially elevated.
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11. Permissions & Fee and Test Year
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The Fear of Physician scale was formally published in 1998 by Virginia P. Richmond, R. S. Smith, Alan M. Heisel, and James C. McCroskey in Communication Research Reports.
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In accordance with the open-access scholarship philosophy maintained throughout Dr. James C. McCroskey's career, the FOP instrument is placed in the public domain for non-commercial educational, scholarly, and clinical research purposes. No licensing fees or formal royalty payments are required to administer the scale in non-profit academic research, university teaching, or clinical evaluation environments. Scholars and practitioners utilizing the scale are required to maintain standard academic attribution by citing the original 1998 validation paper. The scale, alongside Dr. McCroskey's extensive library of communication apprehension instruments, is archived and accessible via the official James C. McCroskey memorial repository hosted at jamescmccroskey.com.
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12. References
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The following academic sources provide foundational theoretical and psychometric documentation for the Fear of Physician scale and its related constructs:
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- McCroskey, J. C. (1977). Oral communication apprehension: A summary of recent theory and research. Human Communication Research, 4(1), 78–96. https://doi.org/10.1111/j.1468-2958.1977.tb00599.x
- McCroskey, J. C. (1984). The communication apprehension perspective. In J. A. Daly & J. C. McCroskey (Eds.), Avoiding communication: Shyness, reticence, and communication apprehension (pp. 13–38). SAGE Publications.
- Richmond, V. P., & McCroskey, J. C. (1998). Communication: Apprehension, avoidance, and effectiveness (5th ed.). Allyn & Bacon.
- Richmond, V. P., Smith, R. S., Heisel, A. M., & McCroskey, J. C. (1998). The impact of communication apprehension and fear of talking with a physician and perceived medical outcomes. Communication Research Reports, 15(4), 344–353. https://doi.org/10.1080/08824099809362141
- Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Consulting Psychologists Press.
- Street, R. L., Jr., Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education and Counseling, 74(3), 295–301. https://doi.org/10.1016/j.pec.2008.11.015
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13. Items of the Scale
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Instructions: Please indicate the degree to which each statement applies to you when communicating with your physician using the following response scale:
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\n 1 = not at all
\n 2 = somewhat
\n 3 = moderately so
\n 4 = very much so\n
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- When communicating with my physician, I feel tense.
- When communicating with my physician, I feel calm.
- When communicating with my physician, I feel jittery.
- When communicating with my physician, I feel nervous.
- When communicating with my physician, I feel relaxed.
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“,n “excerpt”: “The Fear of Physician (FOP) scale is a 5-item psychometric assessment developed by Richmond, Smith, Heisel, and McCroskey (1998) to measure communication apprehension and anxiety experienced during doctor-patient consultations.”,n “slug”: “fear-of-physician-fop”,n “categories”: [n “Psychological Assessments”,n “Health Psychology”,n “Communication Studies”n ],n “tags”: [n “Fear of Physician”,n “Communication Apprehension”,n “Doctor-Patient Communication”,n “Health Psychology”,n “Medical Anxiety”,n “Psychometrics”,n “McCroskey”n ],n “seo_title”: “Fear of Physician (FOP) Scale: Psychometrics, Scoring & Validity”,n “seo_description”: “Explore the Fear of Physician (FOP) scale: comprehensive psychometric properties, scoring formula, factor structure, and authentic test items by McCroskey et al.”,n “focus_keyword”: “Fear of Physician”n}