Factors Associated With the Quality of the Patient-Doctor Relationship: A Cross-Sectional Study of Ambulatory Mexican Patients With Rheumatic Diseases

BACKGROUND

The patient-doctor relationship (PDR) is a complex phenomenon with strong cultural determinants, which impacts health-related outcomes and, accordingly, does have ethical implications. The study objective was to describe the PDR from medical encounters between 600 Mexican outpatients with rheumatic diseases and their attending rheumatologists, and to identify factors associated with a good PDR.

METHODS

A cross-sectional study was performed. Patients completed the PDRQ-9 (Patient-Doctor Relationship Questionnaire, 9 items), the HAQ-DI (Health Assessment Questionnaire Disability Index), the Short-Form 36 items (SF-36), a pain-visual analog scale, and the Ideal Patient Autonomy Scale. Relevant sociodemographic, disease-related, and treatment-related variables were obtained. Patients assigned a PDRQ-9 score to each patient-doctor encounter. Regression analysis was used to identify factors associated with a good PDR, which was defined based on a cutoff point established using the borderline performance method.

RESULTS

Patients were primarily middle-aged female subjects (86%), with substantial disease duration (median, 11.1 years), without disability (HAQ-DI within reference range, 55.3%), and with deteriorated quality of life (SF-36 out of reference range, 73.7%-78.6%). Among them, 36.5% had systemic lupus erythematosus and 31.8% had rheumatoid arthritis. There were 422 patients (70.3%) with a good PDR and 523 medical encounters (87.2%) involved certified rheumatologists.Patient paternalistic ideal of autonomy (odds ratio [OR], 3.029; 95% confidence interval [CI], 1.793-5.113), SF-36 score (OR, 1.014; 95% CI, 1.003-1.025), female sex (OR, 0.460; 95% CI, 0.233-0.010), and being certified rheumatologist (OR, 1.526; 95% CI, 1.059-2.200) were associated with a good PDR.

CONCLUSIONS

Patient-related factors and the degree of experience of the attending physician impact the quality of the PDR, in Mexican outpatients with rheumatic diseases.

Concordance among patients and physicians about their ideal of autonomy impacts the patient-doctor relationship: A cross-sectional study of Mexican patients with rheumatic diseases

INTRODUCTION

In patient-doctor interaction both parties play a role. Primary objective was to determine if the concordance among rheumatologists and their patients of their ideal of autonomy was associated with a better patient-doctor relationship. Secondary objective was to describe factors associated to a patient paternalistic ideal of autonomy (PPIA).

MATERIALS AND METHODS

This cross-sectional study had 3 steps. Step-1 consisted in translation/cultural local adaption of Ideal Patient Autonomy Scale (IPAS), a 14-items Dutch questionnaire. Step-2 consisted of IPAS validity and reliability in 201 outpatients. Step-3 consisted of the application of IPAS and the patient-doctor relationship questionnaire (PDRQ) to 601 outpatients with a medical encounter, and of IPAS to the 21 attending rheumatologists. Each patient-physician encounter was classified into with/without concordance in the ideal of autonomy and PRDQ scores were compared (Man Whitney U test). Regression analysis was used for associations.

RESULTS

Step-1 followed ISPOR task force recommendations. Patients from Step-2 and Step-3 were representative outpatients with rheumatic diseases. IPAS structure underwent a modification; the 14 items were redistributed into four subscales, further combined into PPIA vs. patient-centered autonomy ideal. IPAS was valid and reliable. There were 497 patients with a preferred ideal of autonomy, primarily (84.9%) PPIA. There were 363 patient-doctor encounters with concordance in the autonomy ideal and their PDRQ-9 scores were higher. Religious beliefs and higher PDRQ-9 item 8 score ("I feel pleased with my doctor´s treatment") were associated to a PPIA.

CONCLUSIONS

Concordance of autonomy ideal among patients and their rheumatologists positively impacts on the patient-doctor relationship.

Filosofía, ciencia y verdad. El diálogo filosófico como método para la enseñanza y el aprendizaje de la filosofía

En este artículo[1] se pretende a partir del diálogo filosófico (como método), abordar brevemente algunos de los problemas más debatidos al interior de la filosofía en la actualidad, tales como: el sentido de la filosofía, la verdad, la objetividad científica, el problema de la racionalidad en las ciencias y el progreso humano. Para este fin se espera, por un lado, dar cuenta de distintos problemas de naturaleza filosófica mediante el carácter discursivo y argumentativo, connatural al diálogo filosófico; y, por otro lado, fomentar el diálogo como método en los procesos de enseñanza y aprendizaje de la filosofía. [1]Este artículo es resultado de la investigación intitulada “racionalidad y progreso en la ciencia. Una propuesta de racionalidad analógica a partir de la epistemología de Evandro Agazzi” (2014- 2017), así como de la estancia investigativa postdoctoral realizada por Carlos-Adolfo Rengifo-Castañeda en el “Centro Internazionale Insubrico Carlo Cattaneo e Giulio Preti per la Filosofía, L Epistemologia, le Scienza e delle Tecniche” della Università degli studi dell insubria. Varese – Italia (2018) y financiada por la Università degli studi dell insubria. Agradecimientos al profesor Fabio Minazzi, director del Centro internazionale Insubrico.

How Can the Problems of An Ethical Judgment on Science and Technology Be Correctly Approached?

Two opposite positions are currently dividing the field of discussion regarding the ethical evaluation of science and technology. On the one hand, many people maintain that such a judgment must not be introduced or, less radically, that it needs not be looked for; on the other hand, several scholars maintain that such a judgment is legitimate or, more radically, mandatory. Therefore, it is advisable to examine the arguments of both parties in order to see not so much which viewpoint is right but, perhaps, to what extent both might be right.

Stimulus- and frequency-specific oscillatory mass responses to visual stimulation in man

Oscillatory mass responses centered at about 20-35 Hz or 100-120 Hz occur (after contrast or luminance visual stimulation, respectively) in the retina and cortex of animals and man and are recorded by electrical or magnetic methods. These oscillatory events reflect stimulus-related uni/multicellular oscillations of the firing rate/membrane potential and result from synchronization of neuronal assemblies selectively responding to the stimulus characteristics. Methodological problems in the study of these events derive from the contiguity in frequency between the ERG or VEP and the oscillatory responses and from the need to reliably define oscillatory events in time and frequency. Two methods (time-frequency analysis by matching pursuit and locking index) have been implemented to approach this issue. Theory and application are reviewed.