Dynamics of doctor-patient relationship: A cross-sectional study on concordance, trust, and patient enablement

Background: The rapid pace of medical advances coupled with specialization and super-specialization, is eroding the traditional doctor-patient relationship. Objective: (a) To study the determinants of core dimensions, such as, concordance, trust, and enablement in a doctor-patient relationship; (b) to explore associations, if any, among these core dimensions. Materials and Methods: A cross-sectional study design with both quantitative and qualitative methods was employed. One hundred and ninety-eight outdoor patients were interviewed as part of the quantitative study. Three dimensions of the doctor-patient relationship, that is, physician patient concordance, trust in physician, and patient enablement were assessed using validated tools. Focus group interviews using an open-ended format among few physicians was carried out as part of the qualitative study. Results: In the quantitative analysis most of the sociocultural factors did not show any significant association with the doctor-patient relationship. However, gender was significantly and strongly associated with trust in the physician. Female patients showed a much lower trust in the physician (50%) as compared to male patients (75%) (OR = 0.33, 95% CI 0.17 - 0.64, Chi Sq = 12.86, P = 0.0003). A qualitative study revealed language and culture, alternative medicines, commercialization of medicine, and crowding at specialist and super-specialist clinics as barriers to a good doctor-patient relationship. Better concordance was associated with improved trust in the doctor (OR = 5.30, 95% CI 2.06 - 13.98, Chi Sq = 14.46, P = 0.0001), which in turn was associated with improved patient enablement (OR = 3.89, 95% CI = 1.60 - 9.64, Chi Sq = 10.15, P = 0.001). Conclusion: Good doctor-patient concordance (agreement) leads to better trust in the physician, which in turn leads to better patient enablement, irrespective of the sociocultural determinants.