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      A Qualitative Study on the Importance and Value of Doctor-Patient Relationship in Iran: Physicians’ Views

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          Abstract

          BACKGROUND:

          Doctor-patient relationship [DPR] refers to verbal and non-verbal communication between doctor and patient, which is of great importance in consultation sessions.

          AIM:

          Therefore, the present study attempts to explore the importance and value of DPR in Iran.

          MATERIAL AND METHODS:

          The method used in the study was conventional content analysis. The data were collected from 21 faculty members (FMs) of Shiraz University of Medical Sciences (SUMS), Shiraz, Iran, who participated in three focus group discussions (FGDs). Transcribed data were analysed using Conventional Content Analysis (CCA) which identified condensed meaning units, subthemes, and themes.

          RESULTS:

          Four themes were extracted from 198 meaning units, 87 condensed meaning units, and 17 subthemes. These included gateway [the role of DPR]; nonlinearity [the nature of DPR]; distortion (quality of DPR in the context); and dysfunctional system (weakness in health system). Generally, results showed DPR to be the gateway to consultations based on non-verbal communication and doctor empathy. The study showed distorted DPR which was due to the dysfunctionality of the health care system.

          CONCLUSION:

          As indicated DPR plays an important role in medical contexts, but if distorted it leads to an unsuccessful outcome. Therefore, to promote DPR, it is necessary to reinforce its structure. Thus, the infrastructure has to be modified and developed at all levels.

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          Most cited references33

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          Doctor-patient communication: a review of the literature.

          L M Ong, J de Haes, A M Hoos … (1995)
          Communication can be seen as the main ingredient in medical care. In reviewing doctor-patient communication, the following topics are addressed: (1) different purposes of medical communication; (2) analysis of doctor-patient communication; (3) specific communicative behaviors; (4) the influence of communicative behaviors on patient outcomes; and (5) concluding remarks. Three different purposes of communication are identified, namely: (a) creating a good inter-personal relationship; (b) exchanging information; and (c) making treatment-related decisions. Communication during medical encounters can be analyzed by using different interaction analysis systems (IAS). These systems differ with regard to their clinical relevance, observational strategy, reliability/validity and channels of communicative behavior. Several communicative behaviors that occur in consultations are discussed: instrumental (cure oriented) vs affective (care oriented) behavior, verbal vs non-verbal behavior, privacy behavior, high vs low controlling behavior, and medical vs everyday language vocabularies. Consequences of specific physician behaviors on certain patient outcomes, namely: satisfaction, compliance/adherence to treatment, recall and understanding of information, and health status/psychiatric morbidity are described. Finally, a framework relating background, process and outcome variables is presented.
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            Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues.

            Ronald M Epstein, Peter Franks, Kevin Fiscella … (2005)
            The goal of patient-centered communication (PCC) is to help practitioners provide care that is concordant with the patient's values, needs and preferences, and that allows patients to provide input and participate actively in decisions regarding their health and health care. PCC is widely endorsed as a central component of high-quality health care, but it is unclear what it is and how to measure it. PCC includes four communication domains: the patient's perspective, the psychosocial context, shared understanding, and sharing power and responsibility. Problems in measuring PCC include lack of theoretical and conceptual clarity, unexamined assumptions, lack of adequate control for patient characteristics and social contexts, modest correlations between survey and observational measures, and overlap of PCC with other constructs. We outline problems in operationalizing PCC, choosing tools for assessing PCC, choosing data sources, identifying mediators of PCC, and clarifying outcomes of PCC. We propose nine areas for improvement: (1) developing theory-based operational definitions of PCC; (2) clarifying what is being measured; (3) accounting for the communication behaviors of each individual in the encounter as well as interactions among them; (4) accounting for context; (5) validating of instruments; (6) interpreting patient ratings of their physicians; (7) doing longitudinal studies; (8) examining pathways and mediators of links between PCC and outcomes; and (9) dealing with the complexity of the construct of PCC. We discuss the use of observational and survey measures, multi-method and mixed-method research, and standardized patients. The increasing influence of the PCC literature to guide medical education, licensure of clinicians, and assessments of quality provides a strong rationale for further clarification of these measurement issues.
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              Socio-economic status of the patient and doctor-patient communication: does it make a difference?

              M Deveugele, Linda de Vries, A Derese … (2005)
              This systematic review, in which 12 original research papers and meta-analyses were included, explored whether patients' socio-economic status influences doctor-patient communication. Results show that patients from lower social classes receive less positive socio-emotional utterances and a more directive and less participatory consulting style, characterised by significantly less information giving, less directions and less socio-emotional and partnership building utterances from their doctor. Doctors' communicative style is influenced by the way patients communicate: patients from higher social classes communicate more actively and show more affective expressiveness, eliciting more information from their doctor. Patients from lower social classes are often disadvantaged because of the doctor's misperception of their desire and need for information and their ability to take part in the care process. A more effective communication could be established by both doctors and patients through doctors' awareness of the contextual communicative differences and empowering patients to express concerns and preferences.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Access Maced J Med Sci
                Journal ID (iso-abbrev): Open Access Maced J Med Sci
                Title: Open Access Macedonian Journal of Medical Sciences
                Publisher: Republic of Macedonia (ID Design 2012/DOOEL Skopje )
                ISSN (Electronic): 1857-9655
                Publication date Collection: 25 October 2018
                Publication date (Electronic): 26 September 2018
                Volume: 6
                Issue: 10
                Pages: 1895-1901
                Affiliations
                [1 ]Depatment of Sociology, Yazd University, Yazd, Iran
                [2 ]Department of Medical Ethics and Philosophy of Health, Shiraz University of Medical Sciences, Shiraz, Iran
                [3 ]Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
                Author notes
                [* ] Correspondence: Kamran Bagheri Lankarani. Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran. E-mail: Lankaran@ 123456sums.ac.ir
                Article
                Publisher ID: OAMJMS-6-1895
                DOI: 10.3889/oamjms.2018.361
                PMC ID: 6236045
                SO-VID: fd6a37cf-d1c2-4c3b-a142-9e2e3d735322
                Copyright © Copyright: © 2018 Ahmad Kalateh Sadati, Seyed Ziauddin Tabei, Kamran Bagheri Lankarani.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

                History
                Date received : 09 June 2018
                Date revision received : 23 August 2018
                Date accepted : 24 August 2018
                Categories
                Subject: Public Health

                Keywords: doctor-patient relationship,agency,health systems,qualitative study
                Data availability:
                Keywords: doctor-patient relationship, agency, health systems, qualitative study

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