Medical choice of chronic patients in a large Russian сity: Situations, practices, factors

Abstract

This article is devoted to the main results of a quantitative empirical study of patients’ choice in a large Russian city. The object of this study was the chronic patients of Samara city, selected using a two-step sample method according to the following criteria: disease type, gender, age (N = 510 p). Research was conducted using the semi-formal interview method. Methodologically the study goes back to an approach which was developed within the framework of cognitive medical anthropology in the theoretical and empirical works of American anthropologists Lynda Garro and James Young, which formulated the principles of the Study of Medical Choice, and the Decision-Making Approach. For this research the problem matter of “remission society”, developed by sociologists and anthropologists Anselm Strauss, Arthur Kleinman and Arthur Frank, is very much relevant. In the article, the results of the choices that chronic patients make out of the alternatives available (appeal to state and non-state biomedicine, to different forms of unconventional medicine, medical and non-medical self-treatment) are structured according to three main situations in an ill patient’s life. These are the following: the situation of first encountering the disease (“the debut of the disease”); the situation of diagnosis and prescription of treatment; the situation of the illness transitioning to a chronic state (exacerbation or control over the disease). It is shown that these situations of choice differ from each other not only by the range of available alternatives for making medical decisions by chronic patients (this conclusion was obtained at the first qualitative stage of the study, brief results of which are also presented in the article), but also by quantitative representation of identical alternatives . Thus, we can observe a significant increase in self-treatment in the third situation, caused by a number of subjective and objective reasons, as well as a significant increase in the proportion of respondents who turned to practitioners of unconventional medicine in a situation after a diagnosis was made. The principles of Study of Medical Choice are adapted in the study to the institutional conditions of the Russian healthcare system, with its inherent range of choices and factors that influence the patient’s medical decision-making. Knowledge of these decisions is necessary in order to understand the direction for reforming the Russian healthcare system and in order to organize medical care which satisfies the needs of patients. This article also presents the results of analyzing certain factors that have seriously affected, based on the respondents’ opinions, a specific solution in the situations studied. A hierarchy of representation of these factors is described for each disease situation. A quantitative representation of solutions inherent to noncompliance was revealed, such as refusing drugs, searching for another doctor, double-checking the diagnosis.