Attitudes of medical students in Lahore, Pakistan towards the doctor–patient relationship

Abstract

Background. A good doctor–patient relationship is the centre stone of modern medicine. Patients are getting increasingly aware about exercising their autonomy and thus modern medicine cannot deliver all its advances to the patients if a good doctor–patient relationship is not established. We initiated this study with the aim to assess the leaning of medical students, who are the future physicians, towards either a doctor-centered or a patient-centered care, and to explore the effects of personal attributes on care such as gender, academic year, etc.Materials & Methods. A cross-sectional study was conducted between July and Sep 2013. CMH Lahore Medical and Dental College Ethical Review Committee approved the study questionnaire. The study population consisted of 1,181 medical students in years 1–5 from two medical colleges. The English version of Patient Practitioner Orientation Scale (PPOS) was used to assess attitudes of medical students towards doctor–patient relationship. PPOS yields a mean score range of 1–6, where 1 signifies tendency towards a doctor centered relationship and 6 signifies patient-centered relationship. The relationship between PPOS scores and individual characteristics like gender, academic year etc. were examined by multiple regression.Results. A total of 783 students formed the final sample (response rate = 92%). Mean PPOS score of the entire sample was 3.40 (± .49 S.D.). Mean sharing sub-scale score was 3.18 (± 0.62 S.D. Mean caring sub-scale score was 3.63 (± 0.56 S.D.). Characteristics associated with most patient-centered attitudes were advanced academic year, having a clinical rotation, foreign background and studying in a private college. Gender, having doctor parents, relationship and residence status had no bearing on the attitudes (p > 0.05).Conclusion. Despite ongoing debate and the emphasis on a patient-centered curriculum, our study suggests that the current curriculum and its teachings are not producing the results they are designed to achieve. Students should be adequately exposed to the patients from the beginning of their medical education in clinical settings which are more sympathetic to a patient-centered care.

Medical Students’ Perceptions of the Doctor-Patient Relationship: A Cross-Sectional Study from Saudi Arabia

“…With respect to gender, two studies from the United States [7] and Nepal [9] showed that female gender was more likely associated with higher PPOS scores when compared to the male gender. Conversely, a study from Pakistan [8] identified no statistical difference across gender.…”

“…Haidet and colleagues showed that students in their earlier years of medical school (pre-clinical years) were more likely to have patient-centered attitudes than those in the later years of medical school (clinical years) [6]. On the other hand, a study from Pakistan by Ahmad and partners found an opposite result, where students in later academic years (clinical years) were more likely to exhibit patient-centered attitudes [8].…”

“…Several earlier studies from the United States, Nepal, Singapore and Pakistan have endeavored to scrutinize the attitudes of medical students toward the physician-patient relationship [1,[6][7][8][9]. However, to the best of our knowledge, no similar study was conducted in Saudi Arabia.…”

Simulated patient’s feedback to improve communication skills of clerkship students

“…In local context of Pakistan, literature reports a study that compared the effectiveness of simulated patients with real patients through mini-CEX to assess communication and clinical skills from student's perspective [34]. Another study conducted at Fatima Memorial Hospital (FMH) Medical and Dental College, where counseling skills were assessed of fourth year medical students using pre-recorded videos and role play showed an improvement in the communication skills of the medical students [14]. At Aga Khan University researchers compared examiner assessment with student self-assessment on communication skills using same rating scale on three OSCE stations [35].…”

“…There is a dire need to enhance the communication skills amongst Pakistani medical students to meet the global criteria of patient centered doctors [14]. Until now, assessment of student's communication skills is in a preliminary stage in most of the medical schools in Pakistan [15] .It is a difficult task due to two main reasons; an increase in the number of medical students and additional responsibilities of the faculty such as educational work, research and health services.…”