Communication patterns in the doctor–patient relationship: evaluating determinants associated with low paternalism in Mexico

Abstract

Background Paternalism/overprotection limits communication between the healthcare professionals and patients and does not promote shared therapeutic decisions. In developed countries, communication patterns have been regulated to promote autonomy, whereas in developing countries, they reflect the physician’s personal choice. The goal of this work was contribute to knowledge of communication patterns used in the clinical practice in Mexico, and identify the determinants that favor a low paternalist/autonomist doctor-patient relationship. Methods A self-report study of communication patterns within a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were performed to analyze paternalism and associated factors. Results A high prevalence (68.7% [95% CI 60.0-70.5) of paternalism was observed among mental healthcare professionals in Mexico. The main determinants of low paternalism/autonomism were the medical specialty (OR 1.67 [95% CI 1.16-2.40]) and the sex, whereby female physicians were more likely to explicitly share diagnoses and therapeutic strategies with patients and their families (OR 1.57 [95% CI 1.11-2.22]). A pattern of highly explicit communication was strongly associated with low paternalism/autonomism (OR 12.13 [95% CI 7.71-19.05]). Finally, a modification effect of age strata on association between communication pattern or speciality and low paternalism/autonomism was observed. Conclusions Among mental healthcare professionals in Mexico, an elevated paternalism prevailed. Sex, medical specialty, and a pattern of open communication were closely associated with low paternalism/autonomism. Strengthening the competencies of health professionals and promoting explicit communication could contribute to achieving a transition towards a more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.

Oncologists´ perspectives on patients´autonomy within advance care planning in Mexico City

“…(Dr.6) Nevertheless, the decision-making process is always informed by the patients' sociocultural contexts 6 . Further, doctors' personal sociocultural contexts also influence how they approach their patients in the decision-making process 7,11 .…”

“…Two cardinal features of this relationship are respect for patient autonomy (PA), understood as the right that autonomous agents have to make decisions aligned with their values 3 , and advance care planning (ACP), the process of documenting patients' decisions and preferences along their entire illness trajectory [4][5][6] . Further, these decisions are informed by individuals' sociocultural backgrounds 7,8 . Consequently, it is important to acknowledge the interconnections present between these two concepts-PA and ACP-because how patients and doctors conceptualize autonomy affects how they approach the discussion and implementation of ACP 9 .…”