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Rathnakar UPet al DOCTOR PATIENT RELATIONSHIP: INFLUENCE OF GENDER AND ROLE

Int J Med Pharm Sci, Aug 2013 / Vol 03 (12)

Page 30

ijmps

Vol 03 issue 12

Section: Healthcare

Category: Research

Received on:25/06/13

Revised on: 14/07/13

Accepted on: 03/08/13

DOCTOR PATIENT RELATIONSHIP: INFLUENCE OF GENDER

AND ROLE

Rathnakar UP1, Anjali Ganesh2, Unnikrishnan B3, Srikanth D1, Ganesh K4,

Ashok Shenoy K1, Ashwin Kamath

1

1Department of Pharmacology, Kasturba Medical College, Manipal University,

Mangalore, KA, India2Department of Business Administration, St. Joseph Engineering College, Vamanjoor,

Mangalore, KA, India3Department of Community Medicine, Kasturba Medical College, Manipal University,

Mangalore, KA, India4Department of Radiodiagnosis, AJ Institute of Medical Sciences, Mangalore, KA, India

E-mail of Corresponding Author: [email protected]

ABSTRACT

Background of study: The doctor-patient relationship is one of the most unique and privilegedrelations. Intricately linked are several intervening factors such as gender, educational qualification as

well as the status of the patients in the society that might influence the quality of doctor-patient

relationship.

Objectives:Since Indian society is predominantly male dominated, a study in the Indian context with

respect to the influence of gender on the doctor patient relationship was carried out. Attempt was made

to understand the disparity between the responses of doctors and patients on various aspects of doctor-

patient relationship.

Research Methodology:Patients attending the clinics in a tertiary care hospital were administered a

Likerts 5-point rated structured questionnaire to record their responses regarding various aspects of

doctor-patient relationship. Also, a structured questionnaire was administered to 50 specialist doctors

who treated the selected respondent patients from the same hospital.

Results:Our study showed that physician gender could be a factor in forming a good doctor patient

relationship as more female patients preferred consulting doctor of same gender relative to males.

Although disagreed by the patients, doctors were more likely to mention that the patients do not adhere

to one doctor. Doctors also opined that power and status influence does affect the doctor patient

relationship.

Conclusion: The patients who rest their trust in their doctors, with due diligence, create a win-win

situation. Equally important is the holistic care and patient centered rather than disease centered

approach to treatment by the doctors.

Keywords:Doctor, Patient, Gender, Relationship

INTRODUCTION

The doctor-patient relationship is one of the most

unique and privileged relations. The quality of

doctor- patient liaison is vital to the practice of

doctors be it physicians, surgeons, radiologists or

dentists. It forms an important basis for the

delivery of high-quality health care, diagnosis and

treatment of the disease.1 Intricately linked are

several intervening factors such as gender,

educational qualification as well as the status of

the patients in the society that might influence the

quality of doctor-patient relationship. This paper

analyses the influence of gender on the doctor-

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patient affiliation. The perspectives of both

doctors and the patients are analyzed.

A high-value doctor-patient relationship is based

on a set of parameters which include the

interpersonal relationship betweenthe patient and

the doctor.2

Racial disparities in healthcareoutcome and an intergrative perspective on doctor-

patient communication and cultural competency

has been described by Perloff et al.3 Use of the

Internet by individuals for finding health

information may affect the relationship between

health professionals and patients.4 Personal

relationship with the doctor has been shown to

influence the choice and course of medical

interventions.5 The context is important in any

medical treatment and the words and attitudes of

doctors and nurses can have great impact on the

patient.6

Besides specific technical skills, successful

encounters withpatients require an understanding

of the many ways in whichpatients may express

themselves. The qualitative study by Hellstrom

et.al (1998) reported on the clinical experiences of

doctors when meeting patientswith fibromyalgia.7

The analysesindicated that doctors tried to comply

with the wishes and demands of patients, and at

the same time avoided perceptions of personalfrustration. They were inclined to be objective and

to act instrumentally, apparently in order to keep

in touch with what gave biomedicalmeaning to an

otherwise incomprehensible phenomenon.

India is a multi-ethnic society with diverse

demographic profile comprising of extremely rich,

poor people belonging to different religions and

communities. Majority of the population comes

from lower middle class strata. Since Indian

society is predominantly male dominated, a study

in the Indian context with respect to the influence

of gender on the doctor patient relationship was

carried out. Attempt was made to understand the

disparity between the responses of doctors and

patients on various aspects of doctor-patient

relationship.

METHODOLOGY

The study was been confined to Mangalore region

of Dakshina Kannada District of Karnataka state,

India. Mangalore has five medical college

hospitals in private sector. As a result there is a

large pool of specialist doctors residing in thisregion. Patient population is also large as they

float from whole of Karnataka, Goa and northern

Kerala, to avail of improved health care facility.

To fulfill the objectives of this study, the patients

attending the clinics of ten different disciplines,

viz., Medicine, Surgery, Radiology, Dermatology,

ENT, Gynecology, Orthopedics, Psychiatry,

Ophthalmology and Cardiology were chosen for

administering the Likerts 5-point rated structured

questionnaire and also for interaction (Table-1).

Stratified proportional sampling technique was

adopted and 20 patients from each of the above

category were selected from a tertiary care

teaching hospital leading to a sample size of 202.

The survey was conducted for a period of three

weeks. The tertiary care teaching hospital on an

average receives about 2000 patients in three

weeks time (as per the data provided by the

hospital administration office).Thus the sample

size comprised of 10 per cent of the population.

The study was confined to the patients attendingthe clinics in the tertiary care teaching hospital. To

identify the opinion of the doctors regarding the

doctor-patient relationship, a structured

questionnaire was administered (Table-2) to about

50 specialist doctors in the chosen disciplines of

the study, who treated the selected respondent

patients from the same hospital that comprised 25

per cent of the patient sample chosen for the study.

An individual interaction session was held with

them to understand their stance to enhance doctor-

patient relationship. The means of the Likerts

scores were compared using Students t-test. SPSS

11.5 software was used for the statistical analysis.

P value

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RESULTS

A total of 202 patients answered the questionnaire

of which 77 were males and 125 were females. 50

doctors belonging to various clinical specialties

also answered the questionnaire. Table 1 shows

the gender difference with regards to the responsesto the various aspects of doctor patient

relationship. Female patients were more

comfortable consulting a doctor of the same

gender. Personal relationship with the doctor also

formed an important reason for consulting a

particular doctor among female patients. Female

patients were more likely to feel strong and

confident after treatment. Male patients disagreed

to a significantly greater extent to the statement

that they do not adhere to one doctor for treatment,

although both the genders strongly disagreed on

not adhering to one physician.

Table 2 shows the comparison of the responses

from doctors and patients. Doctors were

statistically less likely to agree to the following

responses in comparison to the patients the role

of personal relationship, patient satisfaction,

doctors skills, communicability with the doctor

etc. The following aspects were considered by the

doctors to have a greater influence on doctor

patient relationship good rapport with thepatients, power and status of the patient, long

waiting time in the clinics.

DISCUSSION

Influence of gender on perception of various

aspects of doctor patient relationship was studied.

There is difference between the genders with

respect to the comfort factor of the patients if the

doctor is of the same gender, i.e. female patients

are more comfortable with lady doctors. Indian

society is male dominated and women have

reservations and limitations due to subtle

confinements of the society. The mindset that

female feels comfortable with a lady is strongly

rooted in Indian society and has no significance

with the competence of the doctor. The study by

Garciaet al among outpatients of a university

clinic showed that even among women in all

English-proficient groups, gender concordance is

important to their relationships with primary care

physicians.8 A study among final year medical

student showed that their interaction with the

patients is not gender neutral. Both genders weremore attuned to the concerns of patients of their

own gender and were uncomfortable in clinical

examination of the opposite gender.9There is also

a significant difference between the responses of

male and female patients with respect to feeling

of strength and confidence after the treatment. A

study by Sharma (2001) also stated very clearly

that the doctor needed to pay full attention towards

patients symptoms, his story and above all his

anguish and sufferings.10 Listening to the patient

was very important as it promotes the feeling of

strength and confidence in the patients. However it

is also important to note that gender is a

characteristic that is associated with variation in

communication. Women disclose more

information about themselves in conversation,

they have a warmer and more engaged style of

nonverbal communication, and they encourage and

facilitate others to talk to them more freely and in

a warmer and more intimate way.11 Similarly,

female patients strongly feel that personalrelationship with the treating doctor counts a lot in

taking treatment with both male and female

patients mean score on the higher side. It is

extremely important to foster this relationship

especially in the current scenario of rapid

penetration of managed care into the healthcare

market raising concerns for many patients and

doctors about the effects that different financial

and orgamizational features might have on the

doctor-patient relationship.1 In our study, female

patients were also more likely to strongly disagree

of not having consulted the same physician for

their health problems. The reason for change of

physician could be lack of trust, connectedness

with the physician or long waiting time for

consultation. At the same time, the healthcare

system in India allows for specialist consultation

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without the intermediacy of a general physician.

Patients tend to consult different doctors for

different ailments. This also allows for multiple

consultations with different doctors for the same

ailment which may lead to drug related problems

or unnecessary investigations if the information ofprevious consultation is not shared by the patient

or elicited by the doctor. The comparison of the

responses from doctors and patients in our study

showed that the doctors were more likely to agree

that the patients do not stick to one doctor with

long waiting time being a reason for consulting a

different doctor. Doctors strongly feel that the

loyalty factor amongst the patients is declining due

to more affordability, long waiting hours with the

specific doctor, lack of patience amongst the

younger generation, lack of trust and also due to

unavoidable circumstances like geographical

barriers and time constraints. In his observations,

Pandya et al (1995) mentions that it is unethical

for a doctor to take over a patient already under

the care of another doctor without a note of

referral.12

Dissolution of the doctor- patient

relationship also brings in its wake a major legal

handicap. Since the patient is consulting more than

one expert, each of whom is in ignorance of what

the other is doing, no one will acceptresponsibility in the event of a mishap.

Both doctors and patients have agreed that good

rapport and patient satisfaction are important

aspect in doctor patient relationship. Patients these

days have a wide choice of doctors, treatment

including alternative medicines which they

consider to be harmless or have less side effects.

There is also increasing awareness among patients

about the management of common sickness such

as common cold, fever, headache, vomiting as

well as diarrhea. Therefore the patient delight

becomes essential to stick to a same doctor in the

long run. Medical field has become so competitive

these days as the doctors need to strategize their

practice with efficiency, effectiveness,

communication skill, listening skill, cost

consciousness, and curability of the disease.

Therefore doctors themselves have almost

disagreed that the doctors skill is a dominant

factor in doctor-patient relationship.

Statistical test was used to determine if there is any

difference between the responses of the doctors of

the ten different specialties viz., medicine, surgery,ophthalmology, ENT, orthopedics, dermatology,

gynecology, radiology, cardiology, psychiatry.

There was no significant difference between the

responses of the specialists, giving equal treatment

to the patients.

CONCLUSION

Our study showed that physician gender could be a

factor in forming a good doctor patient

relationship as more female patients preferred

consulting doctor of same gender relative to males.

The responses obtained from the female patients

emphasizing the personal relationship and the

positive effect of treatment is in agreement with

the findings of similar studies. Although disagreed

by the patients, doctors were more likely to

mention that the patients do not stick to one

doctor. Doctors also opined that power and status

influence does affect the doctor patient

relationship.

The patients who rest their trust in their doctors,with due diligence, create a win-win situation.

Equally important is the holistic care and patient

centered rather than disease centered approach to

treatment by the doctors. The safety net provided

by the official system of referral and transfer of

medical information in writing in both directions

between general practitioner and consultant or

consultant and consultant is now missing. Worst of

all, disregard for the relationship destroys the

traditional bond of affection between family and

general practitioner. The doctor needs to pay full

attention towards patients symptoms, his story

and above all his anguish and sufferings. This is

one of the failings which a doctor should avoid as

this would leave the patient dissatisfied. Human

beings, be it doctors or any other professionals

come with lot of precincts which hold liable the

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patients as well. The awareness of the human

limitation becomes all the more important in

establishing the trust and faith between the doctors

and patients.

ACKNOWLEDGMENTAuthors acknowledge the great help received from

the scholars whose articles are cited and included

in references of this manuscript. The authors are

also grateful to authors / editors / publishers of all

those articles, journals and books from where the

literature for this article has been reviewed and

discussed. Authors are grateful to IJMPS editorial

board members and IJMPS team of reviewers who

have helped to bring quality to this manuscript.

REFERENCES

1. Goold SD, Lipkin M. The DoctorPatientRelationship: Challenges, Opportunities, and

Strategies. J Gen Intern Med. 1999 ; 14(Suppl

1): S26S33.

2. Kirshner M. The role of informationtechnology and informatics research in the

dentist-patient relationship. Adv Dent Res.

2003 Dec;17:77-81.

3. Perloff RM, Bonder B, Ray GB, Ray EB,Siminoff LA. Doctor-Patient Communication,Cultural Competence, and Minority Health -

Theoretical and Empirical Perspectives.

American Behavioral Scientist.

2006;49(6):835-852 .

4. Kivits J. Informed Patients and the Internet , AMediated Context for Consultations with

Health Professionals. Journal of Health

Psychology 2006;11(2):269-282.

5. Arborelius E, Timpka T, Nyce JM. Patientscomment on video-recorded consultations

the "good" GP and the "bad". Scandinavian

Journal of Public Health 1992; 20(4):213-216.6. Benedetti F. How the Doctors Words Affect

the Patients Brain. Evaluation & the Health

Professions 2002;25(4):369-386.

7. Hellstrom O, Bullington J, Karlsson G,Lindqvist P, Mattsson B. Doctors' attitudes to

fibromyalgia: a phenomenological study.

Scandinavian Journal of Public Health

1998;26(3):232-237.

8. Garca JA, Paterniti DA, Romano PS, KravitzRL. Patient preferences for physician

characteristics in university-based primary

care clinics. Ethn Dis. 2003;13(2):259-67.

9. Zaharias G, Piterman L, Liddell M. Doctorsand patients: gender interaction in the

consultation. Acad Med. 2004 ;79(2):148-55.

10.B.K. Sharma. Trust is the basis of doctor-patient relationship Spectrum. 2001. Available

online at

http://www.tribuneindia.com/2001/20011007/

spectrum/fitness.htm (Accessed on Jan 10,

2010).11.Roter DL, Hall JA. Physician gender and

patient-centered communication: A Critical

Review of Empirical Research. Annu. Rev.

Public Health 2004;25:497519

12.Pandya S. Doctor-patient relationship. IndianJournal of Med Ethics. 1995;3(2).

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Table 1: Gender-wise representation of the patients response regarding various aspects of

doctor-patient relationship

Particular aspects of doctor-patient relationship

Mean of the Likerts score* according to

gender (Standard Deviation)

Males (n=77) Females (n=125)

Doctor spends enough time in educating about the disease 4.35 (0.84) 4.36 (0.71)

My doctor gives equal treatment to all the patients irrespective

of our background4.27 (0.75) 4.22 (0.59)

I feel comfortable with the doctor belonging to the same gender 2.34 (1.33)3.06 (1.33)

[p=0.001]

My doctor is a caring human who listens, understands and is

concerned with my health4.32 (0.52) 4.37 (0.52)

The personal relationship with the treating doctor counts a lot

in taking treatment4.01 (0.91)

4.37 (0.63)

[p=0.001]

I feel great psychological strength and confidence once my

doctor treats me4.43 (0.70)

4.62 (0.53)

[p=0.026]My doctor builds a good rapport with the patients irrespectiveof their religion, caste and region

4.14 (0.87) 4.23 (0.65)

Power and status of an individual influences the doctor patient

relationship2.23 (1.17) 2.06 (0.85)

Communication, health care facilities have enabled me to

understand my health conditions better4.10 (0.87) 4.22 (0.52)

Telecommunication has given me an opportunity to contact mydoctor on real time basis

4.12 (0.69) 4.16 (0.68)

The waiting time is long and sometimes it becomes the reason

for changing the doctor1.73 (0.97) 1.71 (1.01)

I do not stick to a single doctor for the treatment of my

identical sickness 1.77(1.13) 1.45 (0.80) [p=0.02]

Patient satisfaction is important for maintaining the strong

doctor patient relationship4.44 (0.60) 4.37 (0.53)

Doctors skill is significant in sustaining doctor patient

relationship4.40 (0.49) 4.46 (0.53)

Being the patient I should be allowed to ask as many questions

as I want about my disease4.53 (0.60) 4.51 (0.50)

Doctor should not mind if patient requests for a second opinion 3.87 (0.78) 3.94 (0.85)

Irrespective of my affordability I should be offered the best

possible treatment options4.40 (0.59) 4.35 (0.51)

Doctor always discusses with me different treatment options

available 4.13 (0.90) 4.3 (0.54)

Doctor encourages patient to learn from internet1.32 (0.62) 1.42 (0.90)

Doctor does not mind if I communicate apart from regular

visits3.90 (0.93) 4.06 (0.76)

Doctor always discusses the nature of seriousness of disease

with the patients4.19 (0.83) 4.24 (0.72)

*Score of 1 = Strongly disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly agree

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Table 2: Comparison of the responses from the doctors and patients regarding various aspects of

doctor patient relationship

Particular aspects of doctor-patient relationship

Mean of the Likertsscore* (StandardDeviation)

Patients (n=202) Doctors (n=50)

I spend enough time to educate my patient regarding his/her

disease4.36 (0.76) 4.30 (0.79)

I give equal treatment to all the patients irrespective of their

background4.24 (0.66) 4.32 (0.91)

I feel comfortable with the patient belonging to the same gender 2.78 (1.37) 3.18 (0.98)

I listen to all aspects concerned with my patients health 4.35 (0.52) 4.20 (0.61)

The personal relationship with the patients counts a lot in giving

treatment

4.23 (0.77)

[p=0.003]3.84 (1.09)

I instill psychological strength and confidence in my patients4.55 (0.61)

[p

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