BACKGROUND: Changes in public attitudes toward "authorities" in general, as well as shifts in medical practice toward participative models of diagnosis and treatment, imply fundamental transformations in the patient-doctor relationship. However, consistency in reciprocal role expectations cannot be assumed, and this study reveals significant discrepancies in attitudes and behaviors in primary health consultations. METHODS: We conducted a study in the tri-lingual northeastern Italian region of South Tyrol to determine whether perceptions of the patient's role were congruent or differed. In a mixed method approach, the quantitative research part consisted of a survey with 34 identical questions for general practitioners (n = 109) and adult primary care patients (n = 506) on verbal communication, self-initiative and health literacy, interpersonal and social qualities of the patient-physician relationship, and formal aspects of the consultation. Patients were interviewed via telephone, and general practitioners responded online. In the qualitative part, 26 semi-structured in-depth interviews were conducted with the patients and analyzed. RESULTS: General practitioners considered patients' communicative efforts (p < 0.001), self-initiative (p < 0.001), compliance (p = 0.0026), and openness regarding psychosocial issues (p < 0.001) to be significantly more important, whereas patients showed a tendency to give increased importance to formal aspects such as politeness and hygiene (p < 0.001). Perception of the patient's role differed significantly between the Italian and German linguistic groups. CONCLUSIONS: Patients and general practitioners differ in their understanding of patients' roles. These data suggest that a considerable proportion of the population lacks a clear and tangible idea of the active role they could play in consultations. Targeted information on the identified aspects of patient-provider communication may facilitate participatory behavior and positively impact the longitudinal quality of the patient-general practitioner relationship.

Apollis Institute for Social Research and Opinion Polling 39100 Bolzano Italy

Department of Applied Social Sciences Faculty of Humanities Charles University 18200 Prague Czech Republic

Department of Public Health Medical Decision Making and HTA University of Health Sciences Medical Informatics and Technology Tyrol 6060 Hall in Tyrol Austria

Faculty of Education Free University of Bolzano 39100 Bolzano Italy

Institute of General Practice and Public Health College for Health Care Professions Claudiana 39100 Bolzano Italy

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