Abstract
BackgroundPaternalism/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.MethodsA 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.ResultsA 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.ConclusionsAmong 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.
Highlights
Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making
A total of 68.7% of the evaluated population presented a considerable degree of paternalism
66.5% of mental health professionals said that they withheld some information from their patients
Summary
Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the doctor–patient relationship, the principle of respect for autonomy [1] implies that patients receive information from their doctors about their diagnosis, treatment and prognosis in an adequate and appropriate way that allows them to make informed decisions and that, in dialogue with their doctors, patients can choose. Lazcano‐Ponce et al BMC Med Ethics (2020) 21:125 their own degree of participation in this process [2] In this regard, there is evidence of clinical cases in which, under certain cultural, social or religious circumstances, communicating all the available information could be harmful to patients [3]. The paternalistic attitude assumes that doctors always know what is best for their patients [11], while from the perspective of reciprocity, the medical staff collaborate with their patients, patients’ relatives, and others to give them a significant opportunity to participate in healthcare [12]
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