Change in Student Physicians' Views on Authority Relationships with Patients

Lavin, Bebe; Haug, Marie R.; Belgrave, Linda Liska; Breslau, Naomi

doi:10.2307/2136845

Cited by 19 publications

(8 citation statements)

References 27 publications

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“…This is consistent with studies showing lower empathy and patient-centeredness among people high in authoritarian and elitism sociopolitical attitudes [58–60]. Furthermore, there are studies showing that medical authoritarianism increases over the course of medical education [61,62] while empathy decreases [61,63,64]. The causal relationship is unclear; empathy and authoritarianism may be independently affected by experiences in medical school.…”

Section: Discussionsupporting

confidence: 83%

Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: A report from the CHANGES study

Ryn

Phelan

Burke

et al. 2014

Patient Education and Counseling

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Objective Medical school curricula intended to promote empathy varies widely. Even the most effective curricula leave a significant group of students untouched. Pre-existing student factors influence their response to learning experiences. We examined the individual predictors of first semester medical students’ attitudes toward the value of physician empathy in clinical encounters. Methods First year students (n = 4732) attending a stratified random sample of 49 US medical schools completed an online questionnaire that included measures of dispositional characteristics, attitudes and beliefs, self-concept and well-being. Results Discomfort with uncertainty, close-mindedness, dispositional empathy, elitism, medical authoritarianism, egalitarianism, self-concept and well-being all independently predicted first year medical students’ attitudes toward the benefit of physician empathy in clinical encounters. Conclusion Students vary on their attitude toward the value of physician empathy when they start medical school. The individual factors that predict their attitudes toward empathy may also influence their response to curricula promoting empathic care. Practice implications Curricula in medical school promoting empathic care may be more universally effective if students’ preexisting attitudes are taken into account. Messages about the importance of physician empathy may need to be framed in ways that are consistent with the beliefs and prior world-views of medical students.

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Section: Discussionsupporting

confidence: 83%

Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: A report from the CHANGES study

Ryn

Phelan

Burke

et al. 2014

Patient Education and Counseling

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“…A shift from the professionals-patients relationships of authority and dependence to that of equality and mutuality has been most clearly demonstrated in patientphysician relationships and in the context of medical care (Haug & Lavin, 1981;Lavin, Haug, Belgrave, and Breslau, 1987;Blanchard, Labrecque, Ruckde-schel, & Blanchard, 1988).…”

Section: Introductionmentioning

confidence: 99%

Patient-Nurse Collaboration in Nursing Practice: A Korean Study

2002

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“…Studies which have specifically examined authoritarianism as a psychological trait in medical trainees and physicians in western nations have been conducted but have received very little attention. Research shows that about 20% of North American medical students score high on authoritarian scales [105] and authoritarianism increases through the years of medical training, especially in males [106,107]. To illustrate the lack of attention to this area, we can look to Joseph M. Merrill and colleagues study of authoritarianism in North American medical students [105].…”

Section: Boxmentioning

confidence: 99%

“…"Indeed, social dominance orientation robustly predicts the endorsement of hierarchy-enhancing and hierarchy-justifying intergroup attitudes such as racism, sexism and support for harsher criminal sentences for minority offenders and disapproval of hierarchy-attenuating ideologies and redistribution policies such as social welfare, civil rights and multiculturalism" [107] It should therefore be alarming that scores on SDO can be high among certain medical students as they enter school (associated with lower perspective taking/empathic attitudes) [113]; since SDO can be groomed by environmental context, or even provoked by status reminders and cues such as money [114,115], it is far more concerning that SDO elevates through the course of medical training [116]. When researchers manipulate environmental conditions so as to increase perceptions of power, individuals with the highest baseline SDO scores show even further increases in SDO [117].…”

Section: Boxmentioning

confidence: 99%

From Authoritarianism to Advocacy: Lifestyle-Driven, Socially-Transmitted Conditions Require a Transformation in Medical Training and Practice

Prescott

Logan²

2018

Challenges

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The epidemic of socially-rooted, lifestyle-driven non-communicable diseases (NCDs; also referred to as socially-transmitted conditions) has now overtaken infectious diseases as the leading cause of human mortality. Despite this reality, physician education, training and practice within industrialized nations is heavily slanted toward the biopharmaceutical (and away from the psychosocial) aspects of prevention and treatment. As we underscore, the current state of physician training and practical application of guidelines pertaining to lifestyle is paltry and untenable. However, the solution is not a few more hours of nutritional biochemistry to check off the curricula box. Physician readiness for the current NCD crisis will require a philosophical shift in medicine-at-large, including candidate pooling. Recent elections in the United States and Europe have cast a spotlight on the public health consequences of political authoritarianism. However, we highlight that authoritarianism-and its related facets of social dominance orientation and Machiavellianism-are not exclusive to political candidates. Here, we open a dialogue on authoritarianism in westernized medicine as a starting point in order to encourage the development of critical research and to explore its potential as a barrier to patient care. We suggest that authoritarianism and its prejudices act as a border wall to the World Health Organization's broad vision of global health, cultural competency and patient autonomy. Moreover, the evidence reviewed here would suggest that in the context of the NCDs crisis, westernized medicine is long overdue a Flexner Report for the 21st Century.

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Change in Student Physicians' Views on Authority Relationships with Patients

Cited by 19 publications

References 27 publications

Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: A report from the CHANGES study

Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: A report from the CHANGES study

Patient-Nurse Collaboration in Nursing Practice: A Korean Study

From Authoritarianism to Advocacy: Lifestyle-Driven, Socially-Transmitted Conditions Require a Transformation in Medical Training and Practice

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