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

2020 ◽  
Author(s):  
Eduardo Lazcano-Ponce ◽  
Angelica Angeles-Llerenas ◽  
Rocío Rodríguez-Valentín ◽  
Luis Salvador-Carulla ◽  
Rosalinda Domínguez-Esponda ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Healthcare Professionals ◽  
Mental Healthcare ◽  
Communication Patterns ◽  
Self Report ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Open Communication ◽  
Ethical Implications ◽  
Explicit Communication

Abstract Background: Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician’s personal choices. The goal of this work was contribute to knowledge of the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomism. 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 analyse 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 medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians 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 modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomism was observed. Conclusions: Among mental healthcare professionals in Mexico, an elevated paternalism prevailed. Gender, 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 the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.

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

2020 ◽  
Author(s):  
Eduardo Lazcano-Ponce ◽  
Angelica Angeles-Llerenas ◽  
Rocío Rodríguez-Valentín ◽  
Luis Salvador-Carulla ◽  
Rosalinda Domínguez-Esponda ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Healthcare Professionals ◽  
Mental Healthcare ◽  
Communication Patterns ◽  
Self Report ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Open Communication ◽  
Ethical Implications ◽  
Explicit Communication

Abstract Background: Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician’s personal choices. The goal of this work was contribute to knowledge of the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomy.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 analyse 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/autonomy were medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians 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/autonomy (OR 12.13 [95% CI 7.71-19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed.Conclusions: Among mental healthcare professionals in Mexico, an elevated paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening the competencies of health professionals and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.

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

2020 ◽  
Author(s):  
Eduardo Lazcano-Ponce ◽  
Angelica Angeles-Llerenas ◽  
Rocío Rodríguez-Valentín ◽  
Luis Salvador-Carulla ◽  
Rosalinda Domínguez-Esponda ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Healthcare Professionals ◽  
Mental Healthcare ◽  
Communication Patterns ◽  
Self Report ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Open Communication ◽  
Ethical Implications ◽  
Explicit Communication

Abstract Background: Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician’s personal choices. The goal of this work was contribute to knowledge of the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomy.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 analyse 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/autonomy were medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians 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/autonomy (OR 12.13 [95% CI 7.71-19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed.Conclusions: Among mental healthcare professionals in Mexico, an elevated paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening the competencies of health professionals and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.

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

2020 ◽  
Author(s):  
Eduardo Lazcano-Ponce ◽  
Angelica Angeles-Llerenas ◽  
Rocío Rodríguez-Valentín ◽  
Luis Salvador-Carulla ◽  
Rosalinda Domínguez-Esponda ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Healthcare Professionals ◽  
Mental Healthcare ◽  
Medical Specialty ◽  
Communication Patterns ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Open Communication ◽  
Therapeutic Decisions ◽  
Explicit Communication

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.

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

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Eduardo Lazcano-Ponce ◽  
Angelica Angeles-Llerenas ◽  
Rocío Rodríguez-Valentín ◽  
Luis Salvador-Carulla ◽  
Rosalinda Domínguez-Esponda ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Healthcare Professionals ◽  
Communication Patterns ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Open Communication ◽  
Explicit Communication

Abstract Background Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician’s personal choices. The goal of this study was to contribute to knowledge on the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor–patient relationship characterized by low paternalism/autonomy. Methods A self-report study on communication patterns in a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were used to analyse paternalism and associated factors. Results A high prevalence (68.7% [95% CI 60.0–70.5]) of paternalism was observed among mental health professionals in Mexico. The main determinants of low paternalism/autonomy were medical specialty (OR 1.67 [95% CI 1.16–2.40]) and gender, with female physicians being 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/autonomy (OR 12.13 [95% CI 7.71–19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed. Conclusions Among mental health professionals in Mexico, high paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening health professionals’ competencies and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.

scholarly journals The doctor–patient relationship and psychiatric out-patients

1992 ◽  
Vol 16 (7) ◽  
pp. 425-427
Author(s):  
Sami B. Timimi
Keyword(s):  
Clinical Practice ◽  
Medical Model ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Working Models

A trainee in psychiatry soon realises that one of the great differences between working in psychiatry and in other specialities is the presence of different working models, each with its own boundaries, which are often kept quite separate in clinical practice (see, for example, Straus et al, 1964). This naturally presents the newcomer with many dilemmas. In this paper I want to explore my own experiences in using psychodynamic approaches within the setting of a routine (medical model) psychiatric out-patient clinic.

scholarly journals THE DOCTOR-PATIENT RELATIONSHIP, PERSONALITY, MOOD, AND FUNCTIONING IN OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S161-S162
Author(s):  
Lauren S Atlas ◽  
Richard Zweig
Keyword(s):  
Older Adults ◽  
Social Adjustment ◽  
Mood State ◽  
Interpersonal Problems ◽  
Self Report ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Combined Models ◽  
Trust In Physicians ◽  
Medical Burden

Abstract Personality pathology has been tied to mental and physical health in older adulthood. Less is known regarding the combined impact of personality and the doctor-patient relationship on mental health outcomes. This study examined relationships between personality, mood, and trust in physicians. Participants (N=170) were a sample of primary care older adults ages 60-99 (M = 70.73, SD = 7.054) who completed self-report measures of personality traits (NEO-FFI), processes (IIP-PD-25), depression (GDS-30; PHQ-9), social adjustment (SAS-SR) and trust in one’s physician (GTIP). Medical burden data (CIRS) were retrieved from medical records. After adjusting for relevant covariates such as age, perceived health, cumulative illness burden, and income security there were several significant predictive relationships. In combined models more neuroticism (NEO-N, ß = .082, p < .000) and lower trust (GTIP, ß = -.025, p = .014) but not agreeableness (NEO-A, ß = -.006) or interpersonal problems (IIP-25, ß = .254) predicted depression. In combined models, higher neuroticism (NEO-N, ß = .018, p < .000) and interpersonal problems (IIP-25, ß = .186, p = .002) but not agreeableness (NEO-A, ß = -.003) or trust (GTIP, ß = -.002) predicted social adjustment. The results are consistent with previous findings that neuroticism predicts both depression and social adjustment in older adults. In addition, lower trust augmented neuroticism to predict depression. Results suggest that apart from general personality risk factors, situational personality processes such as trust in physicians may affect mood state, whereas personality processes such as interpersonal problems contribute to longer term functional impairment.

scholarly journals Mentalising skills in generic mental healthcare settings: can we make our day-to-day interactions more therapeutic?

2018 ◽  
Vol 42 (3) ◽  
pp. 102-108 ◽  
Author(s):  
H. J. Welstead ◽  
J. Patrick ◽  
T. C. Russ ◽  
G. Cooney ◽  
C. M. Mulvenna ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Healthcare Professionals ◽  
Mental Healthcare ◽  
Self Report ◽  
Clinical Implications ◽  
Healthcare Settings ◽  
Before And After ◽  
The Mean ◽  
Short Intervention

Aims and methodCaring for patients with personality disorder is one of the biggest challenges in psychiatric work. We investigated whether mentalisation-based treatment skills (MBT-S) teaching improves clinicians' understanding of mentalising and attitudes towards personality disorder. Self-report questionnaires (Knowledge and Application of MBT (KAMQ) and Attitudes to Personality Disorder (APDQ)) were completed at baseline and after a 2-day MBT-S workshop.ResultsNinety-two healthcare professionals completed questionnaires before and after training. The mean within-participant increase in scores from baseline to end-of-programme was 11.6 points (95% CI 10.0–13.3) for the KAMQ and 4.0 points (1.8–6.2) for the APDQ.Clinical implicationsMBT-S is a short intervention that is effective in improving clinicians' knowledge of personality disorder and mentalisation. That attitudes to personality disorder improved overall is encouraging in relation to the possibility of deeper learning in staff and, ultimately, improved care for patients with personality disorder.Declaration of interestNone.

FC31-02 - Is it ethical not to prescribe placebo? the patient's perspective on the usage of placebo for the treatment of depression - a comparative study

2011 ◽  
Vol 26 (S2) ◽  
pp. 1990-1990 ◽  
Author(s):  
K. Feffer ◽  
U. Nitzan ◽  
P. Lichtenberg ◽  
S. Lev-Ran ◽  
S. Fennig
Keyword(s):  
Depressive Episode ◽  
Healthy Subjects ◽  
Self Report ◽  
List Type ◽  
Ethical Aspect ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Treatment Of Depression ◽  
Potential Benefits ◽  
To Receive

IntroductionThe current stands of the medical establishment exclude usage of placebo in the clinical setting on ethical grounds. No attempt has been made to clarify the viewpoint of the psychiatric patient regarding the matter.ObjectiveTo compare the viewpoint of healthy subjects to that of patients who suffered from depressive episode.Aims1)Investigate the willingness of subjects in both groups to receive placebo for the treatment of depression, and2)compare both groups’ views regarding the ethical aspect of placebo usage (e.g. doctor-patient relationship, patient's autonomy, etc).MethodWe enrolled 81 patients and 107 healthy subjects. Patients were recruited from an out-patient clinic and were diagnosed, in the past or present, as suffering from a depressive episode. All subjects were briefed thoroughly about the efficacy, potential benefits and limitations of placebo in treating depression and then completed a self-report questionnaire.Results64% of the patients (N = 50) expressed consent to use placebo in case they suffer again from depressive symptoms, compared to 79% (N = 85) of healthy subjects (p< 0.05). In both groups over 70% of the subjects do not perceive prescribing placebo as a deceit or as an act that diminishes the patients' autonomy (p>0.05).ConclusionsThe majority of patients agreed to receive placebo medication as a first line treatment, and do not feel that it will negatively affect their sense of autonomy or doctor-patient relationship. These findings question some of the ethical justification of excluding placebo from the clinical practice and call for further discussion in the subject.

Reibl v. Hughes: The Consent Issue

1987 ◽  
Vol 32 (1) ◽  
pp. 66-70 ◽  
Author(s):  
J. Arboleda-Florez
Keyword(s):  
Legal Issue ◽  
Mental Disability ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Open Communication ◽  
Legal Decisions ◽  
Humanistic Approach ◽  
Consent To Treatment ◽  
The Right ◽  
The Impact

Inviolability of the person is the basic principle underpinning the concept of consent to treatment. Although it is not a new concept, consent has become a major medico-legal issue because of a shift, within the doctor/patient relationship, towards more autonomy for the patient and less paternalism from the doctor. This change has been given further impetus by legal decisions such as Reibl v. Hughes and Hopp v. Lepp. In this paper the author reviews the nature of the changes and the impact of the legal decisions on the doctor/patient relationship. He concludes that a legal approach to consent is sterile if it is a substitute to open communication between the doctor and the patient, or to their acceptance of a principle of “equality of two participants”. Consent is based on the basic principal of the inviolability of the person, that is, the right, at all times, of every individual not to have his body tampered with without his permission or agreement, and to be the whole decision-maker on matters that affect his physical integrity. This right is not absolute: it may be abrogated by the state for health or judicial reasons, or the person may not be in a position to exercise it, such as when unconscious or because of mental disability. This paper will review present Canadian laws on consent. It will contrast the legal approach to consent to the ethical-humanistic approach which could be developed within the context of the doctor/patient relationship.

scholarly journals Longitudinal team training program in a Norwegian surgical ward: a qualitative study of nurses’ and physicians’ experiences with implementation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Randi Ballangrud ◽  
Karina Aase ◽  
Anne Vifladt
Keyword(s):  
Patient Safety ◽  
Clinical Practice ◽  
Training Program ◽  
Healthcare Professionals ◽  
Patient Safety Culture ◽  
Team Training ◽  
Trial Registration ◽  
Open Communication ◽  
Convenience Sample ◽  
Surgical Ward

Abstract Background Team training interventions to improve team effectiveness within healthcare are widely used. However, in-depth knowledge of how healthcare professionals experience such team training curricula and their implementation processes, as well as how contextual factors impact implementation, is currently missing. The aim of this study is therefore to describe healthcare professionals’ experiences with the implementation of a longitudinal interprofessional team training program in a surgical ward. Methods A descriptive design was applied based on qualitative semi-structured focus group interviews with 11 healthcare professionals. A convenience sample of physicians (n = 4), registered nurses (n = 4), and certified nursing assistants (n = 3) was divided into three professionally based focus groups, which were interviewed at three time intervals over a period of 1 year. Intervention The validated and evidence-based team training program Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) was implemented in a surgical ward at a hospital between January 2016 and June 2017. The team training program included three phases: 1) assessment and planning, 2) training and implementation, and 3) sustainment. Results Healthcare professionals’ experiences with the content of the team training program varied from valuing the different elements of it to seeing the challenges in implementing the elements in clinical practice. A one-day training course was found to be especially beneficial for interprofessional collaboration at the ward. Over time, the nursing staff seemed to maintain their motivation for the implementation of the tools and strategies, while the physicians became less actively involved. Contextual ward factors influenced the adoption and utilization of the tools and strategies of the program both positively and negatively. The healthcare professionals’ experienced the implementation of the team training program as positive for the patient safety culture at the ward in the forms of increased awareness of teamwork and open communication. Conclusions The study suggests that the implementation of a team training program in a surgical ward is dependent on a set of factors related to content, process, context, and impact. Knowledge on how and why a team training program work supports the transferability to clinical practice in further planning of team training measures. Trial registration The study is part of a larger research project with a study protocol that was registered retrospectively on 05.30.17, with the trial registration number ISRCTN13997367.

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