Carl J Smith and Professor Lynn England, Sociology
Carl J. Smith Doctor-Patient Relationships in Mexico Faculty Mentor: Lynn England, Sociology In biomedicine, doctor-patient relationships are considered crucial in providing good health care. Studies have shown that specific aspects of good doctor-patient relationships impact patient perceived recovery in non-life-threatening disorders. One of the major determining factors for successful doctor-patient relationships is the level of communication and information exchange achieved during the consultations. As a developing nation, Mexico has shown an increase in reliance on technological medicine as apposed to physician clinical skills. Some feel that Mexico may suffer from a de-emphasis on the importance of doctor communication skills.
I evaluated the impact that the doctor-patient relationship has on patient-perceived recovery and satisfaction in Mexico. Relatively few studies have been performed in Mexico, a developing nation, which can be compared with studies performed in the United States. I chose this study because of my background in Latin American Studies, because I am a pre medical student, and because of my desire to do volunteer services in Latin America in the future as a physician. The information from this study can be utilized in conjunction with previous studies to assess what measures are appropriate in educating physicians and patients alike on the importance of doctor-patient relations.
I hypothesized that the manner in which the doctor dealt with the patient would significantly impact the way the patient perceived the outcome of the visit. In order to assess the importance of doctor-patient relationships, I planned on meeting with a variety of primary care physicians that I had contacted in various parts of the Republic of Mexico. To achieve this goal, I observed over one hundred consultations of patients facing non-life-threatening disorders in the clinical setting. I observed these visits with eight different doctors in four different states. At the discretion of each of these doctors, I surveyed over seventy of the patients who were treated. During each consultation I recorded the number of questions asked by the doctor and the patient, the duration of the visit, and took advantage of the opportunity to learn more about clinical practices in Mexico. After each visit I surveyed the patient regarding their perception of the doctors attention—information exchange, socio-emotional concerns, competency, etc. I also questioned the patients in regards to their satisfaction with the doctor, their expectations of recovery, and their socio-economic background.
Various adjustments were needed throughout the research in order to accommodate the doctors, patients, and the validity of the study. Tape recording the consultations made the doctors and patients uneasy. I decided that it was more appropriate to listen attentively and record the necessary data by hand. Many of the patients were not educated enough to understand the basic wording of the survey, so I found it more effective to read it to them and explain the questions in simple terms. I sensed that many patients were reluctant to speak against the doctor when they disagreed with the treatment. In order to overcome this obstacle I emphasized more explicitly the confidentiality of the questions. My most pressing concern dealt with the lack of diversification within the clinical setting—I felt this would cause outliers to exist within the data.
I soon realized that most patients were satisfied in everyway with their private practitioner; otherwise they would have found another doctor to help them with their needs. I decided to resolve this predicament by primarily observing in clinics where the patient was not able to decide which doctor would attend them.
Data analysis is a pertinent aspect of research. My research results replicated many of the studies previously done by others. I found a strong correlation between patient perceptions concerning the doctor’s attention during the consultation and their attitude with regards to their expectations for recovery, their willingness to follow the doctor’s instructions, and their willingness to seek medical attention from the same doctor in the future. Of the doctors that were rated mediocre to poor in the categories dealing with their treatment of the patient—patient, respectful, understanding, relaxed, expressive, kind, and capable—33% of their patients did not feel that their symptoms would be alleviated, did not plan on following all instructions, or did not plan on returning. Those doctors that were rated good to excellent in these categories had only 3% of their patients with adverse perceptions. The doctor’s patience and understanding seemed to effect most the patient’s perception of hope for recovery, compliance with instructions, etc. There was no correlation between the patient perception of the visit and the following: the number of questions asked by the doctor and patient (an average of ten and 2 respectively), gender (64% female), age (27 yr old avg), occupation (50% homemakers, 34% manual labor, 12% commerce, 3% professional), education (junior high school avg.) and income (approx. avg. 300 US$ per month).
It is essential for physicians to realize the importance of effective doctor-patient relations. I saw that a doctor who is condescending, rude, or indifferent is not as effective in helping their patient to feel confidence in their instructions—aside from the loss of cliental and threat of a lawsuit. It is mutually beneficial for both the patient and the doctor when there is a comfortable environment created through respect, patience, concern, and good communication. The doctor benefits with continuing visits from the patient and more opportunities to help, while the patient has a better overall understanding of what measures to take in order to regain health and more confidence and trust in the doctor. I think that this should be more fully emphasized as part of a physician’s medical training. Overall, I feel that Mexico has very responsible and caring doctors. However, I recommend that the causes of lower quality doctor-patient relationships should be investigated. I feel that these problems are possibly due to the relatively low number of doctors available to the public. Many doctors are over booked within hospitals and aren’t given adequate time to effectively care for their patients. Another problem I see is that their doctors are underpaid, as little as $2 US per visit in many regions—causing the doctors to sacrifice quality patient care in order to see as many patients as possible in the shortest period of time.