Physicians’ Treatment Decisions: Sociological Theory

Abstract

This paper aims to present the social characteristics of the Physicians that evaluate the differences among the treatment decisions they make on the patients who have similar health problems. The physician’s involvement in the patient’s treatment appeared to be chronic as the physician becomes sensitive to different factors such as gender, status, location and the educational background of the physician and the social class of the patients as well (Eliot et al., 2003).

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Social issues can somehow influence but it prevailed that factors such as the work setting and capabilities of the physicians answered the questions regarding treatment decisions for the patients. However, a more detailed and specific study should be considered in viewing social characteristics of the physician’s behavior about the treatment for patients.

Introduction

Most commonly, Physicians try to involve their patients in decision making process about the treatment. Patients often received interviews which are related to their evaluation of being satisfied on the treatment process that they have got from their attending physicians (Aiken et al., 2002). More often than not, physicians who have similar health problems with the patients try to get the opinions of their patients to be able to decide on the treatment of such health problem (Makoul, 2001).

Some views this kind of practice as irrelevant and not considerable because they are patients and not Doctors, though many people agreed on the interaction between Physicians and patients (Elster, 1989). Greater satisfaction from patients was correlated to the practice style of the physicians which enables them to suggest what they may have in mind to achieve a better and faster treatment from the health problem they are suffering from (Makoul, 1998).

However, Physicians may have dissimilar decisions regarding the same health problems that their patients have. Not all patients who have similar problems in health should be treated on a uniform basis because behavior does vary a lot on the Physician’s point of view and patient as well (Calhoun, 2002). Thus, what should resemble one’s decision? It will greatly affect the factors involve on the environment such as social interactions and approaches that come out on the process of treatment. A theory will explain what behavioral process undergoes within this area and how should the physicians and patient relate to the decisions in terms of the social context in a particular scenario (Berberoglu, 2005).

When a patient seeks health care, the patient perceptions of the physician and vice versa could influence the patient-physician interaction and it may affect greatly on the satisfaction and adherence of the patients. It will reveal that factors which not merely have a relation with the health problem can be determined as a kind of disparity because of the unfair treatment (Kohn et al., 2000). It had been a great challenge to establish legitimacy for the physicians to practice their ethical code that covers the fair treatment system on every case they handle (Best, 1990).

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Patients characteristics, such as social class, income, and ethnic background, and physician’s social characteristics, such as age, education (training), and work environment could potentially alter the decision making process in the physician-patient relationship {1779 Eisenberg, John M. 1979; 1772 Clark, Jack A. 1991}. The physician’s location and the culture of the practice can also be a factor in terms of providing the same level of care to all patients. Clark points out that to describe the decision-making process, it has to be in “the context of ‘sociologic influences’ (including patient, physician and practice setting characteristics)” {1772 Clark, Jack A. 1991}.

Physicians Assertiveness on Patients Treatment

One of the most effective interactions between a Doctor and a patient is by building a good rapport which will last until the treatment process ends. The main issue here is that how would a Doctor decide on a particular treatment procedure for different kinds of patients with similar health problems from various social classes (Hack et al., 2005). Indeed, there are three essential and fundamental goals a Doctor should have during the treatment which are; the establishment of good interpersonal relationships, creating bridges which will become the way wherein process of exchange on information will go through as what is expected, and lastly, the motivation for the patients to be involved in the decision making processes.

Thus, making the physician’s care with the interaction between them would make the treatment more successful (WHO, 1996). However, social issues such as status can affect the behavior of the physician. Typically, patients who came from rich family are more likely to be treated well than patients who are more economically challenged (Burkett et al., 1976).

The relativity of the physician’s decision regarding the health problems of various patients can also be taken into account into the type of communication they have. The widespread promotion of this perception within the medical field which may turn into a negative assumption can result in poor communication between both parties (Bosk, 1979a).

And sometimes it may result in an invasive problem or worst. The misconceptions about being an independent decision-maker by the Physicians can be a cause of having a negative outcome. The assertiveness of the physicians is somehow depicted in the kind of health problem a patient has and the way they relate to them even though not all physicians and patients have a close relationship with each other even on the treatment process which usually last for a long time (Lukoschek et al., 2003).

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Characteristics of Physician-Patient Communications Behavior

Moreover, discrepancies in communication have been linked with various results from the patient’s point of view. Sometimes it includes misconceptions about the lack of adherence to medication regimes, more pain intensity and poor pain relief, less satisfaction with the health care, and shoddier ratings of the mood and total well-being (Nguyen et al., 2005). This is often seen on the medical visits that health care providers have, and is associated with particular characteristics such as older age, minority status, and lower education and income (Arora, 2003).

There have been many types of research that examined education or communication interventions. Even though it had been tagged with variations when it comes to the experimental designs and sample size, the majority of the data showed similarities and came up with a certain result (McDonald et al., 2000). It depicted that such patient-targeted interventions can lessen the barriers that hinder with the communication and improve the factors that affects their behavior (Lerman et al., 1990). But still, it appeared that it is very important to determine the reasons why and how physician- patient executes effects and also to whom and under what kind of situations they may be varied (Von Korff et al., 2003).

The perceptions of physician- patient of the patients are seen on the interaction during a medical encounter and thus represent an imperative set of variables to take account of in this issue. It is said that those patients who view their physicians as being more caring, and provides more information during a medical visit have been agreed to have a higher rate of satisfaction regardless of the social issues stated earlier.

Satisfaction accounts to have a developed sense of control, better acquisition of health information and more functional capabilities (Hughes, 1971). On the other hand, some patients view their physicians as nonchalant to talk about or discuss about the health condition were more likely to be seen as not having enough pain control, depressed or anxious mood, and not in a good functioning (Bensman et al., 1963). Thus, patients come into a varying opinion in terms of their preferences for the involvement in decision making and for disclosing information about what they feel. It regards more to the physician’s ability to comprehend what the patients might have in mind and not because of the social status the patients have (Klein, 1998).

Studies have presented two kinds of approaches in evaluating physician and patient communication behavior. First is by the objective evaluation of recognizable behaviors and the second one is through the perception of patients. The first approach includes the necessity of using intricate, time- consuming procedures and the dependence on quantitative summation of collected data. Evidences recommend that patients assume their own and behaviors of the physicians along a qualitative dimension also. In addition to, pragmatic data indicate that how patients assume and interpret events during the medical acquaintance may have a larger impact on subsequent patient results than the real behavior of the physician.

The participation of the patient in a communication with the physician is a key factor for good health outcomes. An effective communication or a trusting relationship can be affected when the physician and the patient are from different cultures or speak different languages. The experience of illness is subjective and determined by culture. The options available to an individuals in response to symptoms are bound by cognitive and linguistic categories of illness distinctive of every culture {240 Angel,Ronald 1987; 1555 Bates,Maryann S. 1997}.

Hence, when patient and physician work to improve health with two different cultures, their categories of illness collide, creating a barrier. This cultural or language barrier may compromise the acquirement of indispensable information for an accurate diagnosis {1789 Richardson,L.D. 2003} or it could result in misinterpretation of symptoms {1791 Flores,G. 2002}.

Doctors’ biased expectations, patients’ perceptions of discrimination, linguistic differences mark the communication between minority patients and physicians {1344 Perloff, Richard M. 2006}. When a patient-physician interview occurs, it was found that language is not a significant predictor of disparities, while race has a significant effect on the participation of the patients, i.e. white patients have a higher participation than non-white patients {1345 Cegala,Donald J. 2006; 1561 Bao,Y. 2007}.

Having limited English proficiency came as not a substantial barrier in a physician interview {1561 Bao,Y. 2007} because patients reduce the language barriers by choosing a physician who speaks the same language or to go to physician that have translators available. On the other hand, researchers argues that it is respect what creates a more positive effect on a patient-physician encounter and is primarily associated with familiarity rather than sociodemographic characteristics. Their study found that physicians provide more information and express more positive affect when the physician is more respectful towards a patient {1793 Beach,M.C. 2006; 1665 Blanchard,J. 2004}.

The lack of adherence to treatment of low-acculturated minority parents may be the result of lack of English proficiency and therefore lack of understanding of the medical plan, or may be related to their culture-based beliefs about illness {1355 Canino,Glorisa 2006}.

Having the ability to comprehend and respond to the requirements that a good rapport should have and can be enumerated on this certain aspect. The culture can give the identity of one person but however it still depends on the environment of the patient and physician. It should be taken into consideration that two persons who do not share the same culture and language must be assisted by someone who can help both parties. Barriers such as culture and language is not a reason to mistreat someone whom you do not share the same interests.

Discussion

Physician Background Education

One of the major things to be considered is the history of the trainings that the physician has undergone. The authority of the physician comes from the kind of education He had before. If the physician have had a professional training and have been introduced to different prospective regarding the duties and responsibilities in carrying ones position, then the physician would handle his authority better (Atkinson, 1984). Thus, training and certification affects the character and behavior of the physician as to their assumptions of professionalism on the part of their abilities. Disparity reveals on treating patients who are not on the same levels as where they are (Fox, 1957).

Physician training creates behavior that includes verbal and non-verbal acts of dominance. Parson believes that the physician needs power to maintain the physician authority over the dependant patient {1795 Parsons,Talcott 1999}. Usually the formal curriculum stipulates a set of educational experiences and evaluations upon the student that reinforce a democratic point of view. Even though, Parson think that physicians has fiduciary responsibility for the care of the sick based on the expertise gained through training and experience {1778 Parsons,Talcott 1975}.

However, according to Professor Habermas (1981), the later action model of Parson quite became a clash with his earlier action model though Parson obscured it. In addition to, Habermas stated that Parson was inadequate on his ideas about the ‘life world’ which was built up only from the intersubjective communication. Parson’s fictional supposition of relationship between physician and patient’s orientations on one side and the productive prerequisites of systems hindered him from pointing out the symbolic life worlds of the two. One may suffer from distortion for the reason of their subordination to the rationalizing possibilities of money and power (Habermas, 1981).

To assess the training and experience effect on the care for the sick Wilson study the perception of unfair treatment among different lever of training. Wilson found that medical students were generally more likely than physicians to perceive unfair treatment of patients. “First-year medical students were more likely than fourth-year students, and fourth-year students more likely than physicians, to perceive unfair treatment” {1664 Wilson,E. 2004}.

However, student participation within the medical school setting and teaching hospital in a non-formal curriculum also develops a professional personality about specific rules about how doctors should behave, think and feel. Bloom express that adult socialization is important in the career of the professional {1334 BLOOM, SAMUEL W. 1963}. Also, power is repeatedly “constructed, negotiated, and exercised” during interactions and relationships between individuals in medical settings. {1295 Jaye,Chrystal 2006}. Moreover, the patient sees this dominant behavior negatively {1566 Betancourt,J.R. 2006} affecting outcomes and treatment adherence.

Therefore, the provider training could affect treatment provided. On the other hand, medical school of origin also affects where the student is going to provide services. Less traditional schools have their students serving in disadvantaged communities {1596 Ko,M. 2007}. This could serve as a good training which will depict on their attitudes or behaviors on how they will treat the patients accordingly having a fair treatment and as much as possible disregard the practice of disparity.

Once on the physician office, training and experiences determine the physician behavior toward the patient as well as patient preconception of the physician. During this contact period each one exerts his perception of dominance. Irish et al. studied conversation pattern between physician and patient to evaluate dominance. She found that patient interrupted more the physician although they are portrayed as low in dominance {1525 Irish,Julie T. 1995}.

A physician’s training never ends but the degree of expertise in a specific area is determined by his specialty. A comparison between levels of specialty and therefore the physician training shows some differences on physician and patient behavior. Family physicians were rated higher than internists, cardiologists, and cardiothoracic surgeons when the patient lifestyle was evaluated {1563 Barnhart,J.M. 2006}.

Meanwhile, specialist where more apt to recommend early screenings about their area of expertise than family doctors, general practitioners or other specialties {1608 Bhosle,M. 2007}. On my own experience, the specialist opinion have more weight that a family practitioner. Indeed, a specialist will be more effective in giving advices because they have already maintained and looked after the condition of a particular area which signifies expertise. A specialist will be more reliable than a family practitioner though also because sometimes a family practitioner often relies on the suggestions and dependency on the previous conditions that the patient had.

Socio-economic Status (SES) and Education

Disparities in the adherence to screening and treatment guidelines are partly expected due to racial/ethnic and socioeconomic disparities in access to health care. While, patient SES appears to affect physician perceptions more than race. Physicians are more inclined to perceive patients with low SES more negatively on several dimensions than they do patients with middle to high SES. For example, physicians stereotypes of low-education patients makes them think that ”low-education patients are less interested in screening” {1561 Bao,Y. 2007}.

Therefore, physician will interact with patient in different ways, abstaining from discussing screening or treatment alternatives during a clinical encounter. However, on the patient’s view, this appears negatively for the idea that because of discrimination, Physician’s seem to have less interest on them and just function in a broad sense. Discussions about health problems on low- income patients are important as what was stated on one of the interviews. Physicians tend to overlook the side that gives interactions between them and the patient because of presupposing the status of the patients.

Furthermore, Van Ryn observed that physicians provide less information to minorities and patients of lower economic class than to their White or higher SES counterparts. Physician perception on intelligence, education, and rationality of low SES and minority patients may explain why they provide less information. Physicians are less likely to pay attention to or value the involvement of patients who are perceived as less intelligent or rational. Commonly, physicians overestimate minority patients’ education level, especially among African Americans and Hispanic patients. {1552 van Ryn,Michelle 2000; 1604 Kelly,P.A. 2007}.

Similarly to race/ethnicity, persons with lower socioeconomic status are more likely to report that positive self-presentation than higher socioeconomic status persons. Self-presentation is essential for receiving the best medical care {1341 Malat,Jennifer R. 2006}. But the discernment of physicians comes into a minimal reasoning why such patients are deprived of what they should have and the proper care of treating them as how rich patients are treated.

Discrimination and disparity comes in pair on this case. Since then, black people are denied with fair treatment and usually receive substandard care from physicians who practice according to their perception of the patient (Daniels et al., 1996). This happens in reality but many physicians object to this statement as they defend themselves by citing reasons that would secure them and save their names by integration of technical factors (Davis, 1961).

On the other hand, Bao et al argues that SES disparities have taken place mainly because low SES patients visit different physicians to seek treatment, ‘‘between-physician’’ differences and not due to screening or treatment methods {1561 Bao,Y. 2007}. However, it may seem to be biased on the part of the physicians to treat more special their regular patients.

Another issue to be considered are the stereotypes and bias affect diagnostic and treatment decisions {1789 Richardson,L.D. 2003}. Physician perceptions also contributes to racial/ethnic disparities {1568 van Ryn,M. 2006}. The perceptions of the physician stereotypes by patients affect the patient behavior, determining the interval between visits and the how far the patient waits for the condition to worsen before consulting the doctor {1351 Bogart,Laura M. 2004}.

Bogart also found that race/ethnicity do not affect health care satisfaction or stereotype strength, but affect the treatment adherence. Patients may have their own physician’ stereotypes that obstruct an effective communication {1355 Canino,Glorisa 2006}. To improve the effective communication, Clark et al studied the effect of an interactive seminar based on theories of self-regulation. The seminar showed a significant impact on the prescribing and communications behavior of physicians {712 Clark,N.M. 1998}.

Stereotyping could also be depicted on assuming what will be more likely to happen or it appears to be an act of prejudging the patient. Sometimes, it results to neglect a patient who came from a race that has been negatively stereotyped and consequently will not be attended properly in medications (Gallie, 1962).

Gender

Physician’s gender has been studied as source of disparity in the patient-physician relationship. In a meta-analytic review of observational studies, Hall et al. found that female physicians employ a patient centered communication and have longer visits than their male physicians {1794 Hall,J.A. 2002; 1306 Boulis,Ann K. 2003}. When services provided were used to compare male and female physicians it shows that both had comparable diagnostic and therapeutic behavior.

Meanwhile, women physicians communicate sensitivity and caring to patients more easily {{1734 Arnold,R.M. 1988}}. This may account for the general observation that women are more caring and empathic than male physicians. Furthermore, female physicians perceived patients who get engaged in treatment decisions as having effortlessly access to the procedures than their male counterpart {1563 Barnhart,J.M. 2006}. Also, having a specialist (vs. a general practitioner) increase the adherence to treatment {1670 Rushton,J.L. 2004}. However, gender disparities were present for preventive therapy and were explained by a lower perceived risk {1657 Mosca,L. 2005}.

In relationship with conversation interruptions, Irish et al. found that female physicians interrupted more the patient than the male counterpart. Meanwhile, physician interrupted more the female patients than the male patients (Dalton, 1959).

Hence, the effect of gender in this case is not merely seen as a major thing to consider because it will just lead to stereotyping. Saying that females are more caring and males are more on the masculine side are just a part of stereotyping. It does not matter whether the physician is a male or female, still, the patient’s condition will determine the treatment care and the decisions related to it.

Work setting

Friedson (1970) proposed that the physician work setting is the most important determinant of performance. The work setting varies from solo practice to multi-specialty groups where the later provides better quality of care. This is so because they are colleague dependent and possess facilities, equipment, and personnel available for the physician exploits. Also, a group practice provides professional control and supervision. {1743 Freidson,Eliot 1970}

Ross and Duff study support Friedson theory adding that physician personal background (religion and social class) and socialization characteristics (type of medical school, years of training, certification, and years of practice) are not directly related to performance {1327 Ross,Catherine E. 1978}. Although Wang et al. found similar result to Ross and Duff, they suggest that smaller practices provide quality clinical care comparable to larger practices but that they may need increased resources or support to address unmet need {942 Wang,Y. 2006}.

Likewise, Friedson et al. (1972) noted that a perfect location for learning of how members of the medical profession construe and respond to their responsibility on supervising the excellence of practice. It comprises the organization of patient records in a particular, central setting. The roles that physicians should perform for their patients, and to the clinic, are deliberated in stipulations of their working hours.

Depending on the region, country, and culture, small local clinics that focus on specific needs tend to be most favored by clients {1358 Akin,John S. 1997}. The lack of a habitual site of care and the use of hospital clinics and community health centers provides less continuity of care to minority group. Similarly they receive less continuity with the same physician {1802 Doescher,M.P. 2001}. The patients have higher chances of negatively evaluating the physicians because of unfamiliarity.

Being into a field which does not provide enough facilities to be able to maintain the care intended for the patients is one of the major factors that add up in giving less care treatment for the patients (Gusfield, 1981). With that in mind, the character of the physician is not an issue and do not have any relationship with the proper care. Building a good relationship with the patient through continuous check ups and maintaining their health status is an important area to be taken. It is necessary to have a foundation in every treatment procedures that physicians and patients will undergo (Lipschitz, 1989). But for the reason of not having more than enough rations and amenities to provide to patients, not only them suffers but also the physicians because they are the ones who will aid the whole clinic.

Conclusions

Receiving a fair treatment from physicians does not have to consider the characteristics and behaviors that a health care provider possesses. Personal attributes relating to social issues do not influence the decision making process and it was proven by some studies (Light, 1998). Being a health care provider should not be viewed personally as what some patients do. Sometimes the patients evaluate the assertiveness of the physicians through a biased action (Goode, 1967). The portrayals of the factors shown in the discussion part have explained the different aspects and relate it with the proposed social theory.

Physician’s training can be a factor to affect the behavior technically and not socially. Also, the communication skills of both parties should not be taken as a key to fail establishing a good and fair treatment because physicians, in the first place, must know how to adjust for that instance (Cook et al., 1994).

Technically, capabilities of the physicians significantly affect the decision making procedures for treating various patients of the same health problem (Paget, 1988). Characteristics of physicians do not have an effect for their personal preferences regarding the issues of choosing whom to give a well and exceptional treatment (Daniels et al., 2000). Conditions of the patients, and the environment should be the one to look at profoundly because they very much relate to how the completion of such treatment will go through from the point of giving tests up to the medication process (Durkheim, 1938).

Professionalism should be practiced for the part of the physicians (Caplan et al., 1991). Observably, patients have the propensity to stereotype the physicians also that is why predilection process results to risk the credibility of ones behavior (Daniels et al., 2004). Marianne Paget (1988) and Candace West (1984) have given two most important details on how mistakes are fixed in the everyday lingo of the work group. Mistakes are normal but they segregate the interaction between the two. The old saying, “Doctors bury their mistakes,” illustrates more the social process that backdrops fault than it does the literal upshot of patients.

Disparities are not explained by provider characteristics. Extensive evidence points to individual, contextual, and cultural variables that may account for the variance in health outcomes.

To achieve a health care system without disparities many programs, training and policies have been proposed: eradication of stereotypical remarks in the workplace; cultural competence training for emergency providers; increased workforce diversity; and increased epidemiologic, clinical, and services research. The examination and diligent execution of strategies to avoid disparities will be mandatory to eliminate the individual behaviors and comprehensive processes that result in the delivery of unequal care {1789 Richardson,L.D. 2003}.

Thus, the policymakers should promote the liberation of the utmost quality care and high-end continuance of professional standards.

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