A Qualitative Comparative Study of the Doctor-Patient Relationship Model and Decision-Making Style among Chinese and Japanese Doctors

Many studies have documented race and gender differences in health care received by patients. However, few studies have related differences in the quality of interpersonal care to patient and physician race and gender. To describe how the race/ethnicity and gender of patients and physicians are associated with physicians' participatory decision-making (PDM) styles. Telephone survey conducted between November 1996 and June 1998 of 1816 adults aged 18 to 65 years (mean age, 41 years) who had recently attended 1 of 32 primary care practices associated with a large mixed-model managed care organization in an urban setting. Sixty-six percent of patients surveyed were female, 43% were white, and 45% were African American. The physician sample (n = 64) was 63% male, with 56% white, and 25% African American. Patients' ratings of their physicians' PDM style on a 100-point scale. African American patients rated their visits as significantly less participatory than whites in models adjusting for patient age, gender, education, marital status, health status, and length of the patient-physician relationship (mean [SE] PDM score, 58.0 [1.2] vs 60.6 [3.3]; P = .03). Ratings of minority and white physicians did not differ with respect to PDM style (adjusted mean [SE] PDM score for African Americans, 59.2 [1.7] vs whites, 61.7 [3.1]; P = .13). Patients in race-concordant relationships with their physicians rated their visits as significantly more participatory than patients in race-discordant relationships (difference [SE], 2.6 [1.1]; P = .02). Patients of female physicians had more participatory visits (adjusted mean [SE] PDM score for female, 62.4 [1.3] vs male, 59.5 [3.1]; P = .03), but gender concordance between physicians and patients was not significantly related to PDM score (unadjusted mean [SE] PDM score, 76.0 [1.0] for concordant vs 74.5 [0.9] for discordant; P = .12). Patient satisfaction was highly associated with PDM score within all race/ethnicity groups. Our data suggest that African American patients rate their visits with physicians as less participatory than whites. However, patients seeing physicians of their own race rate their physicians' decision-making styles as more participatory. Improving cross-cultural communication between primary care physicians and patients and providing patients with access to a diverse group of physicians may lead to more patient involvement in care, higher levels of patient satisfaction, and better health outcomes.

BackgroundUnder-recognition of depression is common in many countries. Education of medical staff, focusing on their attitudes towards depression, may be necessary to change their behavior and enhance recognition of depression. Several studies have previously reported on attitudes toward depression among general physicians. However, little is known about attitudes of non-psychiatric doctors in Japan. In the present study, we surveyed non-psychiatric doctors’ attitude toward depression.MethodsThe inclusion criteria of participants in the present study were as follows: 1) Japanese non-psychiatric doctors and 2) attendees in educational opportunities regarding depression care. We conveniently approached two populations: 1) a workshop to depression care for non-psychiatric doctors and 2) a general physician-psychiatrist (G-P) network group. We contacted 367 subjects. Attitudes toward depression were measured using the Depression Attitude Questionnaire (DAQ), a 20-item self-report questionnaire developed for general physicians. We report scores of each DAQ item and factors derived from exploratory factor analysis.ResultsWe received responses from 230 subjects, and we used DAQ data from 187 non-psychiatric doctors who met the inclusion criteria. All non-psychiatric doctors (n = 187) disagreed with "I feel comfortable in dealing with depressed patients' needs," while 60 % (n = 112) agreed with "Working with depressed patients is heavy going." Factor analysis indicated these items comprised a factor termed "Depression should be treated by psychiatrists" - to which 54 % of doctors (n = 101) agreed. Meanwhile, 67 % of doctors (n = 126) thought that nurses could be useful in depressed patient support. The three factors derived from the Japanese DAQ differed from models previously derived from British GP samples. The attitude of Japanese non-psychiatric doctors concerning whether depression should be treated by psychiatrists was markedly different to that of British GPs.ConclusionsJapanese non-psychiatric doctors believe that depression care is beyond the scope of their duties. It is suggested that educational programs or guidelines for depression care developed in other countries such as the UK are not directly adaptable for Japanese non-psychiatric doctors. Developing a focused educational program that motivates non-psychiatric doctors to play a role in depression care is necessary to enhance recognition and treatment of depression in Japan.

Çalışmanın amacı, farklı mesleklerde başarılı kişilerin düşünme stilleri ile karar verme stilleri arasındaki ilişkiyi ortaya koymak ve düşünme stilleri ile karar verme stillerini cinsiyet ve meslek grubu değişkenleri açısından incelemektir. Araştırma ilişkisel tarama modelinde yürütülmüş olup; çalışma grubu, amaçlı örnekleme yöntemlerinden kartopu örnekleme yöntemi ile seçilen 184 kişiden oluşturmaktadır. Veri toplama aracı olarak Sternberg-Wagner Düşünme Stilleri Ölçeği (SWDSÖ) ve Melbourne Karar Verme Ölçeği I-II (MKVÖ I-II) kullanılmıştır. Veriler, SPSS 22 programı ile analiz edilmiştir. Sonuçlar, farklı mesleklerde başarılı kişilerin düşünme stilleri ve karar verme stilleri arasında anlamlı ilişkiler olduğunu ortaya koymuştur. Mesleğinde başarılı kişilerin düşünme ve karar verme stillerinde, cinsiyet açısından istatistiksel olarak anlamlı sonuçlar ortaya çıkmıştır. Farklı mesleklerde başarılı kişilerin düşünme stillerinde meslek grubuna göre anlamlı farklar olduğu belirlenmiştir.

Aims: This paper introduces how substantial decision-making and leadership styles relates with each other. Decision-making styles are connected with leadership practices and institutional arrangements. Study Design: Qualitative research approach was adopted in this study. A semi structure interview was use to elicit data from the participants on both leadership styles and decision-making. Place and Duration of Study: Institute of Education international Islamic University

Facing up to the threat in China

BackgroundBurnout has been a major concern in the field of occupational health. However, there is a paucity of research exploring the factors related to burnout among Chinese doctors. Investigation of these factors is important to improve the health of doctors and the quality of healthcare services in China.MethodsThe study population consisted of 1,618 registered hospital doctors from Liaoning province of China. Burnout was measured using the Chinese version of the Maslach Burnout Inventory-General Survey. Occupational stress was measured using the Chinese versions of the Job Content Questionnaire and the Effort-Reward Imbalance Questionnaire. Data were collected on the respondents’ demographic characteristics and work situations. Of the doctors solicited for enrollment, 1,202 returned the completed questionnaire (555 men, 647 women), giving a response rate of 74.3%. A general linear regression model was applied to analyze the factors associated with burnout.ResultsThe burnout mean scores were 11.46 (7.51) for emotional exhaustion, 6.93 (5.15) for cynicism, and 24.07 (9.50) for professional efficacy. In descending order of standardized estimates, variables that predicted a high level of emotional exhaustion included: high extrinsic effort, dissatisfaction with doctor-patient relationship, high overcommitment, working >40 h per week, low reward, and high psychological job demands. Variables that predicted a high level of cynicism included: high extrinsic effort, low reward, dissatisfaction with doctor-patient relationship, high overcommitment, low decision authority, low supervisor support, and low skill discretion. Variables that predicted a low perceived professional efficacy included: high psychological job demands, low coworker support, high extrinsic effort, low decision authority, low reward, and dissatisfaction with doctor-patient relationship.ConclusionsThese findings suggest that occupational stress is strongly related to burnout among hospital doctors in China. Strategies that aim to improve work situations and decrease occupational stress are necessary to reduce burnout, including health education, health promotion, and occupational training programs.

Purpose : The millennial generation was brought up in the digital age, so they were expected to have a different decision-making style than their previous generation. Understanding their psychology was vital for the financial services sector to segment them and develop efficient marketing strategies. Hence, this study aimed to determine the impact of investment decision-making styles on the choice of stock investments among millennial investors in India. Design/Methodology/Approach : A structured questionnaire was adopted to collect responses from millennial investors through snowball sampling. The validity and reliability of the data were tested. Further, the measurement and structural models were analyzed using partial least squares SEM with the help of Smart PLS 3.0 to observe the impact of investor decision-making styles on the choice of stock investments. Findings : Confused by over-choice, impulsiveness, and novelty consciousness styles were found to have a significant positive relationship, whereas brand loyalty and hedonism had a negative impact on the choice of stock investments among millennial investors. Research Limitations/Implications : The study was conducted among millennial investors. Therefore, future research can focus on other generations as independent or comparative studies to get more insights. Originality/Value : To the best of our knowledge, our study is the first to explore the decision-making style of millennial investors in the context of stock market investments with specific reference to emerging markets.

The doctor–patient relationship (DPR) is essential in the process of medical consultations and treatments. Poor DPR may lead to poor medical outcomes, medical violence against doctors, and a negative perception of the healthcare system. Little is known about how DPR is affected during this novel coronavirus disease 2019 (COVID-19) pandemic. This cross-sectional study aimed to explore the DPR during the COVID-19 pandemic. There were 1,903 participants in China (95% response rate) who were recruited during the pandemic online via convenience and snowball sampling. Several questionnaires were used to evaluate participants' attitudes toward DPR, including the Patient–Doctor Relationship Questionnaire (PDRQ-9), Chinese Wake Forest Physician Trust Scale (C-WFPTS), a survey on medical violence against doctors, factors that affect and improve DPR, and general trust in medical services. Results revealed that DPR improved, and doctor–patient trust increased compared to participants' retrospective attitude before the pandemic. In addition, patients' violence against doctors decreased during the pandemic. Better doctor–patient trust and lower violence toward doctors are related to better DPR. Furthermore, we found that the main factors that could improve DPR include communication between doctors and patients, medical technology and services, and medical knowledge for patients. This study helped to better understand DPR in China, which may contribute to future health policies and medical practices in order to improve DPR and doctor–patient trust.

Prescribing and dispensing in Japan: conflict of interest?

ObjectivesTo investigate the difficulties Japanese female doctors face in continuing professional practice.DesignA qualitative study using the Kawakita Jiro method.SettingA survey conducted in 2011 of 13 private Japanese medical school alumni...

BackgroundDuring the COVID-19 pandemic, the performance of Chinese doctors may have led to improved doctor–patient relationships (DPRs). However, it is unclear how doctors and patients perceived the impact of doctors’ communication and empathy skills on DPRs during the COVID-19 pandemic.ObjectiveTo examine the perceptions of doctors and patients on how doctors’ communication skills and empathy skills influence DPRs during COVID-19.Main MeasuresDoctors’ and patients’ perceptions of doctors’ communication skills were measured using the Chinese version of the SEGUE Framework. To measure empathy skills and DPRs, the Jefferson Scale of Empathy and Difficult Doctor-Patient Relationship Questionnaire were administered to doctors, and the Consultation and Relational Empathy Measure and Patient-Doctor Relationship Questionnaire were administered to patients.ResultsA total of 902 doctors and 1432 patients in China were recruited during the pandemic via online or offline surveys (overall response rate of 69.8%). Both doctors and patients rated doctors’ empathy skills as more impactful on DPRs than communication skills. Doctors believed that only their empathy skills influenced DPRs. But patients believed that there was a significant bi-directional relationship between doctors’ communication and empathy skills and these two skills interacted to directly and indirectly influence DPRs, and doctors’ empathy had a greater mediating effect than their communication.ConclusionsDuring COVID-19, there were both similarities and differences between Chinese doctors’ and patients’ views on how doctors’ communication and empathy skills influenced DPRs. The greater effect of doctors’ empathy skills suggests that both doctors and patients attach more importance to doctors’ empathy in doctor–patient interactions. The bi-directional effect on patient outcomes suggests that both doctors’ communication and empathy skills are important to patients’ perceptions of DPRs.

China and Japan have similar cultures but differing healthcare systems. In both countries, admissions of medical error and apologies by doctors continue to be an important but difficult issue. The present study aimed to examine and compare the thoughts and behaviors of Chinese and Japanese doctors when faced with the unexpected death of a patient. Qualitative descriptive analysis was performed to compare the responses of 20 doctors from each country to a hypothetical scenario involving the death of a patient. We found that almost all doctors in both countries considered the treatment process described in the hypothetical scenario to be inappropriate and most would feel regret when faced with the young patient’s death. There was a disagreement concerning responsibility for the patient death among the doctors regardless of their nationality. Doctors decided how to behave facing the patient death after anticipating the bereaved family’s reaction and their initial responses varied widely. Japanese doctors indicated that they would communicate with the patient’s family after a patient died, whereas none of the Chinese doctors indicated they would do so due to a fear of physical violence from the bereaved family. Finally, the decision on whether to disclose the medical error and apology was made after careful and complex consideration. In conclusion, significant differences were observed between Chinese and Japanese doctors with respect to communicating with, and disclosing errors and apologizing to, the bereaved family. We discuss both the ethical and social implications of these differences.

Objective To understand the current situation of doctors and nurses perceptions on doctor-patient relationship and its main influencing factors, and to make recommendations for further healthcare improvement. Methods Based on the survey results of the third-party evaluation of the National Healthcare Improvement Initiative of 136 public tertiary hospitals, we analyzed the doctors′ and nurses′ perceptions on doctor-patient relationship and the influencing factors. SAS 9.4 software was used to conduct variance test of doctors′ and nurses′ basic information and multivariate logistic regression analysis of the influencing factors of doctors′ and nurses′ perceptions on doctor-patient relationship. Results The recognition of doctors and nurses on the statement ofdoctor-patient relationship has been getting better, their career identity and hoping children to study medicine varied significantly (P 1, P 1, P<0.05). Conclusions It is imperative to protect rights of doctors and nurses by enforcing relevant laws and regulations, and improving existing medical dispute handling mechanism. Other measures to this end include higher pay for medical workers equivalent to their value and career identity; media guidance by the government, which will all help create a better medical environment and doctor-patient relationship. Key words: Medical staff; Doctor-patient relationship; Influencing factors; Regression analysis

Martin Buber's (1878-1965) social existentialist thought offers a unique lens through which physician-patient relationships may be interpreted. Buber develops concepts of relationships and dialogue that provide insight into physician-patient relationships. His notions of I-Thou and I-It relationships have relevance for contemporary medical education and practice. Current medical practice is situated in the It-realm of order, objectivity, detachment, abstraction, and experience. This perspective is necessary for medical education and practice but can result in the progressive decline of the interhuman relationships that define medicine. I-Thou relationships, characterized by spontaneity, subjectivity, reciprocity, and recognition and acceptance of the unique other, are essential for humanhood. However, physicians and patients may be constrained from achieving I-Thou relationships by the very nature of their interactions, which are planned and purposive. Buber describes the possibility of a therapeutic relationship that approaches the I-Thou realm. Buber's thought suggests three conceptual shifts that facilitate the development of therapeutic relationships in medical practice and have implications for medical education: (1) from disease-centered to person-centered care, (2) from crisis to everyday management, and (3) from principles and contracts to relationships.

Doctor-patient relationships in China have been deteriorating for the past 10 years. Many Chinese doctors are involved in tense and conflictual doctor-patient relationships. Most patients do not trust doctors or other medical staff and physical attacks on these professionals have become a common event. The Balint group offers a better understanding of the doctor-patient relationship in a safe environment and relieves the doctors from the daily stress. This article (1) describes the specifics of Balint work in China, (2) reports experiences from the first International Balint Conference in China, and (3) compares these experiences with the doctor-patient relationship described by Michael and Enid Balint in the 1950s. Chinese doctors have a great need to communicate, to share their own feelings of powerlessness, helplessness, frustration, and anger. The Balint method is highly appreciated in China. All participants experienced the 2 1/2-day meeting as very helpful. Also, in China, Balint work as relationship work in the analytical group process fosters the ability for introspection alongside openness, unconscious processes, "thinking outside the box," "courage of one's own stupidity," and "beginner's spirit," thus promoting the individuation, the "small but significant change in the personality of the doctor." Perhaps Balint work in China is a contribution to the integration of traditional Chinese virtues: benevolence, tolerance, magnanimity, and prudence with modern medicine. Balint work could be an alternative to the outcome-oriented pressure to perform and to the machine paradigm of biomedicine.