Doctor-patient communication in a Southeast Asian setting: the conflict between ideal and reality
Doctor-patient communication in a Southeast Asian setting: the conflict between ideal and reality
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DOI：
10.1007/s10459-010-9242-7
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发表时间：
2011-03-01
影响因子：
4
通讯作者：
Van der Vleuten, Cees
中科院分区：
文献类型：
--
作者：
Claramita, Mora;Utarini, Adi;Van der Vleuten, Cees
医患沟通在非西方背景下以及与患者的文化和教育背景相关的方面已得到广泛研究。本研究探讨了东南亚背景下理想的医患咨询沟通方式和实际实践。我们在印度尼西亚的一家教学医院进行了这项研究，采用定性和定量设计。对10名内科专家、10名内科住院医师、根据教育程度分为两组的16名患者和10名最高年级医学生进行了深度访谈。对30名内科住院医师、393名不同教育背景的患者以及10名高年级医学生进行观察和量化评价医生和患者在会诊过程中的沟通贡献。 “知情和共同决策”是这项定量研究的中心观察结果。访谈结果显示，东南亚利益相关者赞成合作伙伴式的沟通方式，并揭示了实现这一目标的障碍：医生和患者没有为参与式方式做好准备，而且由于医疗保健系统效率低下，患者负担重，没有足够的时间进行这种类型的沟通。定量研究的结果显示观察到的沟通方式与理想的沟通方式之间存在鲜明对比。无论患者的教育背景如何，家长式作风似乎盛行。我们发现东南亚背景下的医患沟通理想与现实之间存在着尖锐的冲突。进一步的研究应该探讨如何将流行的沟通方式朝所需的方向改变。
Doctor-patient communication has been extensively studied in non-Western contexts and in relation to patients' cultural and education backgrounds. This study explores the perceived ideal communication style for doctor-patient consultations and the reality of actual practice in a Southeast Asian context. We conducted the study in a teaching hospital in Indonesia, using a qualitative and a quantitative design. In-depth interviews were conducted with ten internal medicine specialists, ten internal medicine residents, 16 patients in two groups based on education level and ten most senior medical students. The contributions of doctors and patients to the communication during consultations were observed and rated quantitatively by thirty internal medicine residents, 393 patients with different educational backgrounds and ten senior medical students. The 'informed and shared decision making' is the central observation in this quantitative study. The results of the interviews showed that Southeast Asian stakeholders are in favor of a partnership style of communication and revealed barriers to achieving this: doctors and patients are not prepared for a participatory style and high patient load due to an inefficient health care system does not allow sufficient time for this type of communication. The results of the quantitative study showed a sharp contrast between observed and ideal communication styles. A paternalistic style seems to prevail, irrespective of patients' educational background. We found a sharp conflict between ideal and reality concerning doctor-patient communication in a Southeast Asian context. Further studies should examine ways to change the prevailing communication style in the desired direction.