Communication between doctor and patient is a key part of a clinical experience . Discussions arise about potential differences in communication practice and expectations in different cultures . We investigated the experience and expectations of patients exiting a clinical encounter and asked doctors about their own practice/skill in communication in six locations throughout Vietnam.
When first asked about their satisfaction with the consultation, nearly all patients were either satisfied or very satisfied with both the overall consultation and the doctor’s communication. Robbins et al. reported that patients are most satisfied with consultations when they talk about specific therapeutic interventions, are examined, and receive health education . In our research, most patients reported being satisfied or very satisfied with both the overall consultation as well as with their doctor’s communication. However, when asked about specific communication activities, fewer than 50% of them reported the doctor’s having performed half of the activities on the list at most. This result suggests that Vietnamese patients were perhaps easily satisfied, and/or they had low expectations for the communication with the doctor.
The four items that less than half of the patients expected the doctor to perform were among the five items that doctors had lowest expectation of performing in future. These items may reflect the relatively little attention to the individual in Asian culture and the acceptance of hierarchy . The patients may place themselves in a lower position than the doctors and limit their expectations. A similar result was found in Sri Lanka (a South Asian country) where less than 50% of patients expected doctors to introduce themselves, and to thank the patients . But there were also some differences between the Sri Lankan results and the current study results. In Sri Lanka, patients also expected the doctor to decide the most appropriate treatment modality instead of discussing the available treatment options with them. They wanted precise instructions instead of explanations about the disease and the treatment . This may reflect an even stronger hierarchy in Sri Lanka than in Vietnam. This is in support of the findings of Hofstede who reported that the power distance score was higher in Sri Lanka than in Vietnam .
Verlinde et al.  noted that social differences between doctors and patients could affect communication. Many still follow traditional social rules in which doctors dominate and patients remain passive . Together with better communications training for doctors, increasing the patient's understanding of their partner role needs to be considered.
The variable ‘gender’ was found to affect only one item: women reported that their doctors ‘greet patients’ more than did men. Women may pay more attention to the greeting, or doctors may be more attentive to women. A few differences were found in satisfaction level and perception by different age groups, employment and with facility level, but expectations were similar for all groups at both facility levels.
A systematic review on what patients expect from communication with doctors  reported that qualitative studies identified the key importance of “fostering the relationship”, while quantitative studies did not. Most patients in our quantitative study gave low priority to four of those aspects, perhaps because of cultural differences or perhaps because the study methods did not allow for probing to obtain qualitative information.
In a similar hospital-based study among patients in Yemen, patients rated the doctors’ basic communication skills as good, while higher social skills like involving patients in decision-making were considered weak . Among their patients, those above 45 were grouped as ‘older’ and were also more accepting of the doctors’ communication skills while the younger people were more demanding, similar to the results in our study. Unlike the patients in our study, in other study, gender played no significant role in their patients’ rating of doctors’ skills .
When we looked at overall patient satisfaction with the consultation or with the doctor’s communication, and its relation to specific items on the communication list, it was revealed that satisfaction was significantly related to items of attentiveness and respect, but two items were notably inversely related to satisfaction. Those were ‘Doctors introduces him/herself’ and ‘Doctor asks patient to repeat main issues in treatment course.” It seems that clinicians (and patients) in Vietnam focus on clinical information and examination. However, good medical practice suggests they should maximize therapeutic effects of communication to achieve results through increasing mutual understanding and trust, associated with increased self-efficacy, adherence, social support and improved health . Both doctors and patients in our study recognized a need to strengthen other aspects of communication. However, doctors and patients also agreed that four items on the Western-inspired communication model had lower priority.
An Indonesian report  noted that patients wanted doctors to improve their communication skills, and patients’ expectations about doctors’ communication were very similar to those reported for Western societies. A U.S. review found that doctors and patients agreed on what constitutes competent communication with patients, but that it often did not happen as expected . The doctors in our study felt confident in their communication skills, while recognizing that they could and should improve in most of the items. The expectations of the patients were less ambitious than those of the doctors.
All doctors said they needed more time for consultations. The high SD in their estimates of needed time may be related to specialty or personal speed; however, it could be resulted from the bias of the estimates since each doctor may have their own way to estimate the average time for each consultation. Moreover, the average perceived time needed was significantly higher than the time allocated. This indicates that there is a time pressure, which may force doctors to choose the priorities, during the consultation.
Implications for communication skill training in medical universities
What do these results mean for skills training in medical universities? Firstly, most activities on the list were considered appropriate for doctor-patient communication in Vietnam and were similarly appreciated by both doctors and patients. Also, both clearly recognised that improvements were needed. Claramita and Majoor  noted that although they could not detect differences in the actual practice of communication skills between doctors who had or had not been trained in a skills lab, those who had been trained were more aware of their deficiencies and the need to strengthen them.
Claramita et al.  considered the relevance of a Western communications approach in a Southeast Asian setting and found that not all items would be appropriate. They did find evidence of interest among patients in a more partnership-type approach. In our study, most patients gave lower priority to four items aimed at fostering the doctor-patient relation, as did most doctors. Claramita et al.  proposed a guideline for training communication skills in Southeast Asia that could help bridge the gap between the partnership model of the West and regional culture. The role of the social gradient described by Verlinde et al.  could explain the reticence on both sides to engage in a more partnership style communication.
The study was done in outpatient clinics where most patient-doctor contacts would be the first meeting. For each case, we do not know whether all communication items were needed; e.g., not all patients may have needed discussion about treatment methods. Because the design was a cross-sectional survey based on questionnaires, misunderstandings about terminology could lead to incorrect choice of responses. For patients, trained interviewers recorded the results, but doctors completed the questionnaires on their own, making undetected misunderstandings possible. To explore more deeply expectations of doctors and patients, further studies including a range of clinical specialties and qualitative research methods are needed.
Very few patients or doctors declined to participate, but those few might have had more negative experiences. Patients and doctors received a small payment for their time, which might create bias as they might feel they had to give positive responses. The study investigated communication in a Southeast Asian culture, which could have increased the positive response because of the higher desire for harmony in these cultures.
Finally, it may seem a limitation that the doctors’ responses are based on self-reports, which might not reliably reflect their actual performance. The intention, however, was to identify their perceptions about what a good doctor should do; we did not try to evaluate their actual performance under current conditions.