Particularities of Doctor-Patient Communication, Assessed in 6 Romanian Ambulatory Practices

Introduction: The way doctors collect data, explore patient concerns, discuss and explain the diagnosis will influence the patients’ comfort, satisfaction, attitude and adherence to medical treatment and even their health outcomes. Our aim is to assess structure and patterns of doctor-patient communication in Romanian ambulatory practices.
Materials and methods: We included in our analysis 69 doctor-patient meetings in 6 outpatient clinics (five different specialities, state and private practice), taking place in 3 Romanian cities. Data collection was carried out by non-participatory observation of the time-structure of visits (anamnesis, examination, explanation of diagnosis, treatment-, and lifestyle recommendation, administrative works), proportion of talks and reports belonging to the parts, number of questions asked by each part, and non-verbal behaviour, helping the patient feel comfortable during the visit.
Results: The average length of the meetings was 7.41 minutes. Discussions are less representative in Romanian medical practice. Patients were let to speak about their problems 7 seconds, without interruptions. Administrative duties (registering, writing) took 27% of the time, 42% was represented by examination (physical and instrumental). Explaining diagnosis and treatment accounted for 5% and 9% respectively. There were two doctors (of six) showing different gestures to help the patient feel comfortable during the consultation. Doctors talked 3 times more than patients and had in average 6 questions compared to less than one question, formulated by the patients. Lifestyle recommendations were observed in 2 cases (of the 69).
Conclusions: Although the international literature describes a shift in the doctor’s and patient’s attitude from the traditional paternalistic model towards a partnership, where patients assume a more active role in their healing process, our data suggest a doctor-patient relationship strongly dominated by doctors, a passive behaviour of patients, actually a free-will subordination to the doctor’s high-status (no or few questions, no willingness to participate in decision making).