Medical student attitudes toward the doctor-patient relationship

Abstract

Despite emphasis on the need for curricula that foster patient-centred attitudes among medical students, our data suggest that students in later years of medical school have attitudes that are more doctor-centred or paternalistic compared to students in earlier years. Given the emphasis placed on patient satisfaction and patient-centred care in the current medical environment, our results warrant further research and dialogue to explore the dynamics in medical education that may foster or inhibit student attitudes toward patient-centred care.

Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?

“…Perhaps physicians who value the patient's perspective and participation have an understanding of the patient that facilitates both the task (explaining medical issues, describing treatment options) and relationship (showing respect, encouraging patient participation) functions of communication. Because previous studies have demonstrated that students adopt progressively less patient-centered orientations in later years of medical school (Haidet et al, 2002;Haidet & Stein, 2006), our findings suggest that Table 1 Physician and …”

“…A physician's style of communicating with patients may have evolved from repeated experiences with certain kinds of patients, his or her philosophy of care (Krupat, Rosenkranz, Yeager, Barnard, Putnam & Inui, 2000;Levinson & Roter, 1995), or socialization related to gender (Bertakis, Helms, Callahan, Azari & Robbins, 1995;Hall & Roter, 1998), culture (Waitzkin, 1985), and medical training (Bertakis, Callahan, Helms, Azari, Robbins & Miller, 1998;Bertakis, Helms, Azari, Callahan, Robbins & Miller, 1999;Paasche-Orlow & Roter, 2003). In this investigation, we were particularly interested in whether physicians' communication and perceptions were related to their orientations to the provider-patient relationship (Haidet, Dains, Paterniti, Hechtel, Chang, Tseng et al 2002;Krupat, Bell, Kravitz, Thom & Azari, 2001;Krupat, Hiam, Fleming & Freeman, 1999). That is, do physicians who report a stronger belief in sharing control and understanding the patient's perspective (i.e., a more patient-centered orientation) use more forms of patient-centered communication (e.g., clear explanations, partnershipbuilding, support) and view their patients more favorably than do physicians oriented more toward biomedical issues and doctor control?…”

“…These surveys included measures of patients' demographics, including an estimate of the number of previous visits with the physician. At study entry, physicians completed the Patient-Provider Orientation Scale (PPOS) (Haidet et al, 2002;, a measure that uses two subscales, Caring (importance of understanding patients' perspectives) and Sharing (importance of sharing control with the patient), to measure physicians' orientations to the physician-patient relationship along a doctor-centered/patient-centered continuum. Following visits with patients, physicians completed measures of their perceptions of the patient.…”

Impacto da “Disciplina Relação Médico-Paciente” sobre Atitudes Centradas no Paciente

“…As previously described, the core elements of PPOS, an instrument that has been used to measure student's patient--centred beliefs, are based largely on two dimensions 'caring' and 'sharing' 2,3,15,16 . The last dimension might be defined as sharing the power, the control and the information about the patient's clinical condition.…”

“…These students were enrolled via internet after providing consent for participation through a web-based survey. Student attitudes regarding the relationship between physicians and patients were measured using a previously validated instrument 2,3,15,16 . The Patient-Practitioner Orientation scale (PPOS) is an 18-item instrument originally designed to be administered to either doctor or patients.…”