Power dynamics in doctor-patient relationships: A qualitative study examining how cultural and personal relationships facilitate medication requests in a minority with collectivist attributes.

Abstract

This study examines personal patient-doctor relationships in a minority with collectivist attributes that facilitate medically inappropriate requests of patients. Personal interviews were conducted with 56 (27 family doctors/ 29 patients) members of the Arab minority in Israel. The interviews were transcribed, and thematically analyzed by two coders. Collectivist attributes and long-term patient-doctor relationships, patients' close and mostly familial affiliation to the doctor, and informal policies of recruiting members to sick funds by doctors could result in shifting power dynamics in patients' favor and enhance their confidence to request treatments from their doctor. The present study highlights examining closely-knit patient-doctor relationships in a society with collectivist attributes that foster and reinforce patients' requests. These personal relationships challenge patient-doctor partnerships and the patient-centeredness approach. Instead of collaborating and discussing whether a treatment is needed, patients might pressure for inappropriate treatments and doctors accede. These relationships can be channelled to promote patient centeredness and patient-doctor collaboration. Programs promoting prudent provision of treatments can emphasize that collectivist attributes and personal relationships challenge professional boundaries in patient-doctor relationships. Also, doctors' experiences dealing with patients' pressures to prescribe medications, could serve as a base for these programs.