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Research article
Communication patterns in the doctor–patient relationship: evaluating determinants associated with low paternalism in Mexico.
Angelica Angeles-Llerenas
Instituto Nacional de Salud Publica
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Medical Ethics.
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.
Keywords
paternalism, autonomy, physician-patient communication, self-determination, shared decision-making, patient-centred medicine
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CURRENT STATUS: Published
Submission checks complete
On 20 Nov, 2020
Editorial decision: Minor revision
On 15 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 24 Oct, 2020
Review #1 received
Received 21 Oct, 2020
Reviewers invited
Invitations sent on 05 Oct, 2020
Reviewer #1 agreed
On 05 Oct, 2020
Editor assigned
On 29 Sep, 2020
Submission checks complete
On 28 Sep, 2020
Editor invited
On 28 Sep, 2020
Version 2
Posted 10 Jul, 2020
No comments provided
Editorial decision: Minor revision
On 17 Sep, 2020
Review #1 received
Received 04 Sep, 2020
Reviewer #1 agreed
On 14 Aug, 2020
Reviewers invited
Invitations sent on 13 Aug, 2020
Editor assigned
On 08 Jul, 2020
Submission checks complete
On 07 Jul, 2020
Editor invited
On 07 Jul, 2020
No comments provided
Editorial decision: Major revision
On 24 Apr, 2020
Review #1 received
Received 23 Apr, 2020
Review #2 received
Received 19 Apr, 2020
Reviewer #2 agreed
On 29 Mar, 2020
Reviewer #1 agreed
On 27 Mar, 2020
Reviewers invited
Invitations sent on 23 Mar, 2020
Editor assigned
On 17 Mar, 2020
Submission checks complete
On 16 Mar, 2020
Editor invited
On 16 Mar, 2020
First submitted
On 12 Mar, 2020
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Medical Ethics
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This preprint is under consideration at BMC Medical Ethics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Communication patterns in the doctor–patient relationship: evaluating determinants associated with low paternalism in Mexico.
Angelica Angeles-Llerenas
Instituto Nacional de Salud Publica
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Submission checks complete
On 20 Nov, 2020
Editorial decision: Minor revision
On 15 Nov, 2020
No comments provided
Editorial decision: Minor revision
On 24 Oct, 2020
Review #1 received
Received 21 Oct, 2020
Reviewers invited
Invitations sent on 05 Oct, 2020
Reviewer #1 agreed
On 05 Oct, 2020
Editor assigned
On 29 Sep, 2020
Submission checks complete
On 28 Sep, 2020
Editor invited
On 28 Sep, 2020
Version 2
Posted 10 Jul, 2020
No comments provided
Editorial decision: Minor revision
On 17 Sep, 2020
Review #1 received
Received 04 Sep, 2020
Reviewer #1 agreed
On 14 Aug, 2020
Reviewers invited
Invitations sent on 13 Aug, 2020
Editor assigned
On 08 Jul, 2020
Submission checks complete
On 07 Jul, 2020
Editor invited
On 07 Jul, 2020
No comments provided
Editorial decision: Major revision
On 24 Apr, 2020
Review #1 received
Received 23 Apr, 2020
Review #2 received
Received 19 Apr, 2020
Reviewer #2 agreed
On 29 Mar, 2020
Reviewer #1 agreed
On 27 Mar, 2020
Reviewers invited
Invitations sent on 23 Mar, 2020
Editor assigned
On 17 Mar, 2020
Submission checks complete
On 16 Mar, 2020
Editor invited
On 16 Mar, 2020
First submitted
On 12 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Medical Ethics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Medical Ethics.
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.