Dynamics of doctor-patient relationship: A cross-sectional study on concordance, trust, and patient enablement.
Dynamics of doctor-patient relationship: A cross-sectional study on concordance, trust, and patient enablement.
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DOI：
10.4103/2230-8229.94006
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发表时间：
2012-01
影响因子：
2.7
通讯作者：
Sanyal D
中科院分区：
文献类型：
--
作者：
Banerjee A;Sanyal D
医学的快速发展，加上专业化和超专业化，正在侵蚀传统的医患关系。(a)研究核心维度的决定因素，如，和谐，信任，并在医患关系中的启用;（B）探索协会，如果有的话，这些核心维度。研究设计采用横断面研究，定量和定性相结合的方法。作为定量研究的一部分，198名户外患者接受了采访。三个维度的医患关系，即，医生与患者的一致性，对医生的信任，和患者的启用进行了评估，使用有效的工具。作为定性研究的一部分，在少数医生中进行了开放式的焦点小组访谈。在定量分析中，大多数社会文化因素与医患关系没有显着关联。然而，性别与对医生的信任有显著和强烈的相关性。女性患者对医生的信任度（50%）明显低于男性患者（75%）（OR = 0.33，95%CI 0.17 ~ 0.64，Chi Sq = 12.86，P = 0.0003）。一项定性研究显示，语言和文化、替代药物、药物商业化以及专家和超级专家诊所的拥挤是良好医患关系的障碍。更好的一致性与对医生的信任度提高相关（OR = 5.30，95% CI 2.06 - 13.98，Chi Sq = 14.46，P = 0.0001），而这又与患者能力提高相关（OR = 3.89，95% CI = 1.60 - 9.64，Chi Sq = 10.15，P = 0.001）。良好的医患和谐（协议）导致对医生更好的信任，这反过来又导致更好的患者支持，无论社会文化决定因素如何。
The rapid pace of medical advances coupled with specialization and super-specialization, is eroding the traditional doctor–patient relationship. (a) To study the determinants of core dimensions, such as, concordance, trust, and enablement in a doctor–patient relationship; (b) to explore associations, if any, among these core dimensions. A cross–sectional study design with both quantitative and qualitative methods was employed. One hundred and ninety-eight outdoor patients were interviewed as part of the quantitative study. Three dimensions of the doctor–patient relationship, that is, physician patient concordance, trust in physician, and patient enablement were assessed using validated tools. Focus group interviews using an open-ended format among few physicians was carried out as part of the qualitative study. In the quantitative analysis most of the sociocultural factors did not show any significant association with the doctor–patient relationship. However, gender was significantly and strongly associated with trust in the physician. Female patients showed a much lower trust in the physician (50%) as compared to male patients (75%) (OR = 0.33, 95% CI 0.17 – 0.64, Chi Sq = 12.86, P = 0.0003). A qualitative study revealed language and culture, alternative medicines, commercialization of medicine, and crowding at specialist and super-specialist clinics as barriers to a good doctor–patient relationship. Better concordance was associated with improved trust in the doctor (OR = 5.30, 95% CI 2.06 – 13.98, Chi Sq = 14.46, P = 0.0001), which in turn was associated with improved patient enablement (OR = 3.89, 95% CI = 1.60 - 9.64, Chi Sq = 10.15, P = 0.001). Good doctor–patient concordance (agreement) leads to better trust in the physician, which in turn leads to better patient enablement, irrespective of the sociocultural determinants.