Power Imbalance and Consumerism in the Doctor-Patient Relationship: Health Care Providers’ Experiences of Patient Encounters in a Rural District in India
Restricted accessResearch articleFirst published online November, 2006
Power Imbalance and Consumerism in the Doctor-Patient Relationship: Health Care Providers’ Experiences of Patient Encounters in a Rural District in India
The aim of this study is to explore health care providers’ experiences and perceptions of their encounters with male and female patients in a rural district in India with special reference to tuberculosis (TB) care. The authors conducted semistructured interviews with 22 health care providers, 17 men and 5 women, from the public and private health care sectors. Findings reveal that doctors adopted an authoritarian as well as a consumerist approach in the medical encounter, indicating that power imbalances in the doctor-patient relationship are negotiable and subject to change. Gender was identified as an influencing factor of the doctor’s dominance. A patient-centered approach, acknowledging patients’ own experiences and shared decision making, is called for and should be included in TB control activities. This seems to be especially important for female patients, whose voices were not heard in the medical encounter.
Anandhi, C. L., Nagaraj, V. K., & Kumar, R. (2002). Knowledge and practice pattern of non-allopathic indigenous medical practitioners regarding tuberculosis in a rural area of India. International Journal of Tuberculosis and Lung Disease, 6(6), 553-555.
2.
Begum, V., de Colombani, P., Gupta, S. D., Salim, A. H., Hussain, H., Pietroni, M., et al. (2001). Tuberculosis and patient gender in Bangladesh: Sex differences in diagnosis and treatment outcome. International Journal of Tuberculosis and Lung Disease, 5(7), 604-610.
3.
Bhat, R. (1999). Characteristics of private medical practice in India: A provider perspective. Health Policy and Planning, 14(1), 26-37.
4.
Boeree, M. J., Harris, A. D., Godschalk, P., Demast, Q., Upindi, B., Mwale, A., et al. (2000). Gender differences in relation to sputum submission and smear-positive pulmonary tuberculosis in Malawi. International Journal of Tuberculosis and Lung Disease, 4(9), 882-884.
5.
Brink-Muinen, A. van den, Verhaak, P. F. M., Bensing, J. M., Bahrs, O., Deveugele, M., Gask, L., et al. (2003). Communication in general practice: Differences between European countries. Family Practice, 20(4), 478-485.
6.
Bury, M. (2004). Researching patient-professional interactions. Journal of Health Services Research & Policy, 9(1), 48-54.
7.
Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Social Science & Medicine, 44(5), 681-692.
8.
Deshpande, K., Ravishankar, Diwan, V., Lönnroth, K., Mahadik, V. K., & Chandorkar, R. K. (2004). Spatial pattern of private health care provision in Ujjain, India: A provider survey processed and analyzed with a geographical information system. Health Policy, 68(2), 211-222.
9.
Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nursing Education Today, 24(2), 105-112.
10.
Haddad, S., Fournier, P., Machouf, N., & Yatara, F. (1998). What does quality mean to lay people?: Community perceptions of primary health care services in Guinea. Social Science & Medicine, 47(3), 381-394.
11.
Hall, J. A. (2003). Some observations on provider-patient communication research. Patient Education and Counseling, 50(1), 9-12.
12.
Hall, J. A., & Roter, D. L. (1995). Patient gender and communication with physicians: Results of a community-based study. Women’s Health, 1(1), 77-95.
13.
Hurtig, A. K., Porter, J. D. H., & Ogden, J. A. (1999). Tuberculosis control and directly observed therapy from the public health/human rights perspective. International Journal of Tuberculosis and Lung Disease, 3(7), 553-560.
14.
Jaiswal, A., Singh, V., Ogden, J. A., Porter, J. D. H., Sharma, P. P., Sarin, R., et al. (2003). Adherence to tuberculosis treatment: Lessons from the urban setting of Delhi, India. Tropical Medicine and International Health, 8(7), 625-633.
15.
Jeffrey, P., & Jeffrey, R. (1996). Don’t marry me to a plowman!: Women’s everyday lives in rural North India. Boulder, CO: Westview.
16.
Johansson, E., Long, N. H., Diwan, V. K., & Winkvist, A. (2000). Gender and tuberculosis control: Perspectives on health seeking behaviour among men and women in Vietnam. Health Policy, 52(1), 33-51.
17.
Johansson, E., & Winkvist, A. (2002). Trust and transparency in human encounters in tuberculosis control: Lessons learned from Vietnam. Qualitative Health Research, 12(4), 473-491.
18.
Kamat, V. R. (2001). Private practitioners and their role in the resurgence of malaria in Mumbai (Bombay) and Navi Mumbai (New Bombay), India: Serving the affected or aiding an epidemic? Social Science & Medicine, 52(6), 885-909.
19.
Kim, M., Kols, A., Bonnin, C., Richardson, P., & Roter, D. (2001). Client communication behaviors with health care providers in Indonesia. Patient Education and Counseling, 45(1), 59-68.
20.
Lewin, S. A., Skea, Z. C., Entwistle, V., Zwarenstein, M., & Dick, J. (2004). Interventions for providers to promote a patient-centred approach in clinical consultations [Cochrane Review]. Cochrane Library, 3. Chichester, UK: John Wiley.
21.
Long, N. H. (2000). Gender specific epidemiology of tuberculosis in Vietnam. Unpublished doctoral dissertation, Division of International Health, Karolinska Institute, Stockholm, Sweden.
22.
Long, N. H., Johansson, E., Lönnroth, K., Eriksson, B., Winkvist, A., & Diwan, V. K. (1999). Longer delays in tuberculosis diagnosis among women in Vietnam. International Journal of Tuberculosis and Lung Disease, 3(5), 388-393.
23.
Lönnroth, K. (2000). Public health in private hands: Studies on private and public tuberculosis care in Ho Chi Minh City, Vietnam. Unpublished doctoral dissertation, Göteborg University and Nordic School of Public Health, Göteborg, Sweden.
24.
Lönnroth, K., Tran, T., Thuong, L., Quy, H. T., & Diwan, V. (2000). Can I afford free treatment?: Perceived consequences of health care provider choices among people with tuberculosis in Ho Chi Minh City, Vietnam. Social Science & Medicine, 52(6), 935-948.
25.
Lupton, D. (1997). Consumerism, reflexivity and the medical encounter. Social Science & Medicine, 45(3), 373-381.
26.
Malterud, K. (2000). Symptoms as a source of medical knowledge: Understanding medically unexplained disorders in women. Family Medicine, 32(9), 603-611.
27.
Malterud, K. (2001). Qualitative research: Standards, challenges, and guidelines. The Lancet, 358(9280), 483-488.
28.
Mead, N., & Bower, P. (2000). Patient-centredness: A conceptual framework and review of the empirical literature. Social Science & Medicine, 51(7), 1087-1110.
29.
Nair, D. M., George, A., & Chacko, K. T. (1997). Tuberculosis in Bombay: New insights from poor urban patients. Health Policy and Planning, 12(1), 77-85.
30.
Nair, V. M., Thankappan, K. R., Sarma, P. S., & Vasan, R. S. (2001). Changing roles of grass-root level health workers in Kerala, India. Health Policy and Planning, 16(2), 171-179.
31.
Ong, L. M. L., de Haes, J. C. J. M., Hoos, A. M., & Lammes, F. B. (1995). Doctor-patient communication: A review of the literature. Social Science & Medicine, 40(7), 903-918.
32.
Prasad, R., Nautiyal, R. G., Mukherji, P. K., Jain, A., Singh, K., & Ahuja, R. C. (2002). Treatment of new pulmonary tuberculosis patients: What do allopathic doctors do in India? International Journal of Tuberculosis and Lung Disease, 6(10), 895-902.
33.
Pronyk, R. M., Makhubele, M. B., Hargreaves, J. R., Tollman, S. M., & Hausler, H. P. (2001). Assessing health seeking behaviour among tuberculosis patients in rural South Africa. International Journal of Tuberculosis and Lung Disease, 5(7), 619-627.
34.
Rajeswari, R., Chandrasekaran, V., Shuadev, M., Sivasubramaniam, S., Sudha, G., & Renu, G. (2002). Factors associated with patient and health system delays in the diagnosis of tuberculosis in South India. International Journal of Tuberculosis and Lung Disease, 6(9), 789-795.
35.
Roter, D. L., Hall, J. A., & Aoki, Y. (2002). Physician gender effects in medical communication: A meta-analytic review. Journal of the American Medical Association, 288(6), 756-764.
36.
Silverman, D. (2003). Analyzing talk and text. In N. K. Denzin & Y. S. Lincoln (Eds.), Collecting and interpreting qualitative materials (2nd ed., pp. 340-362). Thousand Oaks, CA: Sage.
37.
Singla, N., Sharma, P. P., Singla, R., & Jain, R. C. (1998). Survey of knowledge, attitudes and practices for tuberculosis among general practitioners in Delhi, India. International Journal of Tuberculosis and Lung Disease, 2(5), 384-389.
38.
Street, R. L. (2002). Gender differences in health care provider-patient communication: Are they due to style, stereotypes, or accommodation? Patient Education and Counseling, 48(3), 201-206.
39.
Thorson, A., Hoa, N. P., & Long, N. H. (2000). Health-seeking behaviour of individuals with a cough of more than 3 weeks. The Lancet, 356(9244), 1823-1824.
40.
Thorson, A., Hoa, N. P., Long, N. H., Allebeck, P., & Diwan, V. K. (2004). Do women with tuberculosis have a lower likelihood of getting diagnosed?: Prevalence and case detection of sputum smear positive pulmonary TB, a population-based study from Vietnam. Journal of Clinical Epidemiology, 57(4), 398-402.
41.
Thorson, A., & Johansson, E. (2004). Equality or equity in health care access: A qualitative study of doctors’ explanations to a longer doctor’s delay among female TB patients in Vietnam. Health Policy, 68(1), 37-46.
42.
Uplekar, M., Juvekar, S., Morankar, S., Rangan, S., & Nunn, P. (1998). Tuberculosis patients and practitioners in private clinics in India. International Journal of Tuberculosis and Lung Disease, 2(4), 324-329.
43.
Uplekar, M. W., Rangan, S., Weiss, M. G., Ogden, J., Borgdorff, M. W., & Hudelson, P. (2001). Attention to gender issues in tuberculosis control. International Journal of Tuberculosis and Lung Disease, 5(3), 220-224.
44.
Uskul, A., & Ahmad, F. (2003). Physician-patient interaction: A gynecology clinic in Turkey. Social Science & Medicine, 57(2), 205-215.
45.
Volmink, J., Matchaba, P., & Garner, P. (2000). Directly observed therapy and treatment adherence. The Lancet, 355(9212), 1345-1350.
46.
World Health Organization. (2005). Global tuberculosis control: Surveillance, planning, financing—WHO report 2005. Geneva: Author.
47.
Xu, B., Fochsen, G., Thorson, A., Kemp, J., & Jiang, Q. W. (2004). Perceptions and experiences of health care seeking and access to TB care—A qualitative study in rural Jiangsu Province, China. Health Policy, 69(2), 139-149.
48.
Yamasaki-Nakagawa, M., Ozasa, K., Yamada, N., Osuga, K., Shimouchi, A., Ishikava, N., et al. (2001). Gender differences in delays to diagnosis and health care seeking behaviour in a rural area of Nepal. International Journal of Tuberculosis and Lung Disease, 5(1), 24-31.
