Sociological analysis of doctor–patient relationships in the healthcare system of the Republic of Belarus on the eve of the COVID-19 pandemic

Abstract

BACKGROUND: One of the most relevant areas of research in the sociology of medicine is the study of the problems of the quality of medical care, the development of approaches and criteria for assessing it at the current stage of development, institutional changes in medicine, the perception of transformational changes in the social institute of medicine by the population. The cornerstone of the health system is the subject relationship in the context of the doctor-patient bond. The determinicity of these interactions by the deontological principles of medicine determines the high level of expectations of patients regarding the personality of the doctor, which, in turn, affects the characteristics of the social status and the spectrum of social roles of medical workers. Despite objective changes in social interactions due to the departure from the paternalistic approach of modern medicine and the strengthening of patient autonomy trends regarding his life and health, the basis for the sustainability of the health system as a social institution remains the patients trust in the doctor, on the one hand, and the high level of professional motivation of medical workers on the other. This becomes the key to the effectiveness of the system, its flexibility and effective opposition to modern challenges, including the COVID-19 pandemic.
 AIM: To study the attitudes and expectations of patients and health professionals regarding aspects of the image, openness and responsiveness of the health system, the risks of its commercialization and compliance with the needs of patients, as well as the peculiarity of motivation of medical workers, conflicts and professional errors, and based on the survey data, to characterize and compare the attitude of patients and health system managers to interaction in the combination of medical worker patient.
 MATERIALS AND METHODS: A sociological study was implemented in 2019 on the basis of a republican sample of patients (n=800) and a representative sample of health managers of the Grodno region of the Republic of Belarus (n=143). For statistical data analysis, the methods of non-parametric statistics of Statistica 10.0 were applied: estimating intergroup differences by calculating the Kruskal-Wallis test, establishing relationships through correlation analysis with calculating the Pearson correlation coefficient.
 RESULTS: The majority (54,3% of patients surveyed) claim that the main factor affecting their attitude and image of institutions and health workers is the reputation of the institutions employees and their clinical experience, in second place in terms of response rates 35,3% the appearance of buildings, equipment of departments and offices, corridors; the third place (28,9%) was taken by the answer preventive work with the population. Managers call the defining motives in the activities of medical workers: professional interest (70,3%), the opportunity to earn money for a living (52,1%), compassion and assistance to the patient (41,3%).
 The results of the study indicate that there are no direct causes and manifestations of conflict situations in the doctorpatient communications.
 In the situation of medical errors, 51,3% of respondents consider the most common subjective errors of the doctor, 22,3% medical. Managers more regard the medical errors encountered as organizational (31,2%) or purely deontological (31,2%). Thus, the majority of managers (62,2%) associate professional deontological errors of medical workers with errors in the behavior of a doctor with patients and relatives of patients. There is a relationship between the level of the leader and the frequency of qualification of professional error as an objective error (r=-0.28; p0.05): the higher the position the leader occupies, the more often he notes precisely objective errors and tends to respond adequately to them.
 Despite the fact that in order to be able to pay for paid medical services, 34,4% of patients are forced to reduce other costs, one in three patients (about 32%) considers additional remuneration to the medical worker directly from patients and their relatives, which is manifested by the so-called corruption environmental pressure however, the vast majority of health managers categorically do not allow such situations.
 CONCLUSIONS: It was revealed that patient attitudes reflect the commercialization of social interactions in the doctor-patient system and create conditions for corrupt environmental pressure, but despite this, relations generally unconditionally maintain a humanistic orientation and priority motive in the form of compassion and patient assistance. Most patients note trust in doctors, two-thirds have never clashed with healthcare professionals, the main image factor is the reputation of the institutions employees and their clinical experience. It was also revealed that the degree of professionalism has a direct impact on the perception of medical errors: for example, patients are much more likely to interpret any incomprehensible situation as a mistake, and health managers, on the contrary, regard the errors encountered more as organizational or deontological, and there is a positive correlation between the level of the leader and the frequency of qualification of professional error as an objective error.