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

Zobrazit více v PubMed

Laidsaar-Powell R.C., Bu S., McCaffery K.J. Partnering with and Involving Patients. In: Martin L.R., DiMatteo M.R., editors. The Oxford Handbook of Health Communication, Behavior Change, and Treatment Adherence. Oxford University Press; Oxford, UK: 2013. pp. 1–51.

Martin G.P. ‘Ordinary People Only’: Knowledge, Representativeness, and the Publics of Public Participation in Healthcare. Sociol. Health Illn. 2008;30:35–54. doi: 10.1111/j.1467-9566.2007.01027.x. PubMed DOI

Luxford K., Safran D.G., Delbanco T. Promoting Patient-Centered Care: A Qualitative Study of Facilitators and Barriers in Healthcare Organizations with a Reputation for Improving the Patient Experience. Int. J. Qual. Health Care. 2011;23:510–515. doi: 10.1093/intqhc/mzr024. PubMed DOI

Shorter E. Bedside Manners: The Troubled History of Doctors and Patients. Simon & Schuster Books; New York, NY, USA: 1985.

Taylor K. Paternalism, Participation and Partnership—The Evolution of Patient Centeredness in the Consultation. Patient Educ. Couns. 2009;74:150–155. doi: 10.1016/j.pec.2008.08.017. PubMed DOI

Kim C., Armstrong M.J., Berta W.B., Gagliardi A.R. How to Identify, Incorporate and Report Patient Preferences in Clinical Guidelines: A Scoping Review. Health Expect. 2020;23:1028–1036. doi: 10.1111/hex.13099. PubMed DOI PMC

Park M., Giap T.-T.-T., Lee M., Jeong H., Jeong M., Go Y. Patient- and Family-Centered Care Interventions for Improving the Quality of Health Care: A Review of Systematic Reviews. Int. J. Nurs. Stud. 2018;87:69–83. doi: 10.1016/j.ijnurstu.2018.07.006. PubMed DOI

Stewart M., Brown J.B., Weston W., McWhinney I.R., McWilliam C.L., Freeman T. Patient-Centered Medicine: Transforming the Clinical Method. CRC Press; Boca Raton, FL, USA: 2013.

Lee R.G., Garvin T. Moving from Information Transfer to Information Exchange in Health and Health Care. Soc. Sci. Med. 2003;56:449–464. doi: 10.1016/S0277-9536(02)00045-X. PubMed DOI

Beresford P., Branfield F. Building Solidarity, Ensuring Diversity: Lessons from Service Users’ and Disabled People’s Movements. Policy Press; Bristol, UK: 2011. pp. 33–46.

Barnes C., Mercer G. Independent Futures. Creating User-Led Disability Services in a Disabling Society. Scand. J. Disabil. Res. 2006;8:317–320. doi: 10.1080/15017410600973523. DOI

Heffernan K. Social Work, New Public Management and the Language of ‘Service User’. Br. J. Soc. Work. 2006;36:139–147. doi: 10.1093/bjsw/bch328. DOI

Akinci F. Privatization in Healthcare: Theoretical Considerations and Real Outcomes. J. Econ. Econ. Educ. Res. 2002;3:62–86.

Keller D.B., Sarkar U., Schillinger D. Health Literacy and Information Exchange in Medical Settings. In: Martin L.R., DiMatteo M.R., editors. The Oxford Handbook of Health Communication, Behavior Change, and Treatment Adherence. Oxford University Press; Oxford, UK: 2013. pp. 23–37.

Nutbeam D. Health Literacy as a Public Health Goal: A Challenge for Contemporary Health Education and Communication Strategies into the 21st Century. Health Promot. Int. 2000;15:259–267. doi: 10.1093/heapro/15.3.259. DOI

Hall M.A., Dugan E., Zheng B., Mishra A.K. Trust in Physicians and Medical Institutions: What Is It, Can It Be Measured, and Does It Matter? Milbank Q. 2001;79:613–639. doi: 10.1111/1468-0009.00223. PubMed DOI PMC

Rowe R., Calnan M. Trust Relations in Health Care—The New Agenda. Eur. J. Public Health. 2006;16:4–6. doi: 10.1093/eurpub/ckl004. PubMed DOI

Croker J.E., Swancutt D.R., Roberts M.J., Abel G.A., Roland M., Campbell J.L. Factors Affecting Patients’ Trust and Confidence in GPs: Evidence from the English National GP Patient Survey. BMJ Open. 2013;3:e002762. doi: 10.1136/bmjopen-2013-002762. PubMed DOI PMC

Petrocchi S., Iannello P., Lecciso F., Levante A., Antonietti A., Schulz P.J. Interpersonal Trust in Doctor-Patient Relation: Evidence from Dyadic Analysis and Association with Quality of Dyadic Communication. Soc. Sci. Med. 2019;235:112391. doi: 10.1016/j.socscimed.2019.112391. PubMed DOI

Steffensen M.B., Matzen C.L., Wadmann S. Patient Participation in Priority Setting: Co-Existing Participant Roles. Soc. Sci. Med. 2022;294:114713. doi: 10.1016/j.socscimed.2022.114713. PubMed DOI

Ohtaki S., Ohtaki T., Fetters M.D. Doctor–Patient Communication: A Comparison of the USA and Japan. Fam. Pract. 2003;20:276–282. doi: 10.1093/fampra/cmg308. PubMed DOI

Rimondini M., Mazzi M.A., Deveugele M., Bensing J.M. How Do National Cultures Influence Lay People’s Preferences toward Doctors’ Style of Communication? A Comparison of 35 Focus Groups from an European Cross National Research. BMC Public Health. 2015;15:1239. doi: 10.1186/s12889-015-2559-7. PubMed DOI PMC

Van den Brink-Muinen A., Verhaak P., Bensing J., Bahrs O., Deveugele M., Gask L., Mead N., Leiva-Fernandez F., Perez A., Messerli V., et al. Communication in General Practice: Differences between European Countries. Fam. Pract. 2003;20:478–485. doi: 10.1093/fampra/cmg426. PubMed DOI

Anderson J.N., Graff J.C., Krukowski R.A., Schwartzberg L., Vidal G.A., Waters T.M., Paladino A.J., Jones T.N., Blue R., Kocak M., et al. “Nobody Will Tell You. You’ve Got to Ask!”: An Examination of Patient-Provider Communication Needs and Preferences among Black and White Women with Early-Stage Breast Cancer. Health Commun. 2021;36:1331–1342. doi: 10.1080/10410236.2020.1751383. PubMed DOI PMC

Bensing J., Rimondini M., Visser A. What Patients Want. Patient Educ. Couns. 2013;90:287–290. doi: 10.1016/j.pec.2013.01.005. PubMed DOI

Cheraghi-Sohi S., Hole A.R., Mead N., McDonald R., Whalley D., Bower P., Roland M. What Patients Want From Primary Care Consultations: A Discrete Choice Experiment to Identify Patients’ Priorities. Ann. Fam. Med. 2008;6:107–115. doi: 10.1370/afm.816. PubMed DOI PMC

Mazzi M.A., Rimondini M., Boerma W.G.W., Zimmermann C., Bensing J.M. How Patients Would like to Improve Medical Consultations: Insights from a Multicentre European Study. Patient Educ. Couns. 2016;99:51–60. doi: 10.1016/j.pec.2015.08.009. PubMed DOI

Prieto Curiel R., González Ramírez H. Vaccination Strategies against COVID-19 and the Diffusion of Anti-Vaccination Views. Sci. Rep. 2021;11:6626. doi: 10.1038/s41598-021-85555-1. PubMed DOI PMC

Hardey M. Doctor in the House: The Internet as a Source of Lay Health Knowledge and the Challenge to Expertise. Sociol. Health Illn. 1999;21:820–835. doi: 10.1111/1467-9566.00185. DOI

Bensing J. Bridging the Gap: The Separate Worlds of Evidence-Based Medicine and Patient-Centered Medicine. Patient Educ. Couns. 2000;39:17–25. doi: 10.1016/S0738-3991(99)00087-7. PubMed DOI

Metzger M.J. Making Sense of Credibility on the Web: Models for Evaluating Online Information and Recommendations for Future Research. J. Am. Soc. Inf. Sci. Technol. 2007;58:2078–2091. doi: 10.1002/asi.20672. DOI

Bensing J.M., Roter D.L., Hulsman R.L. Communication Patterns of Primary Care Physicians in the United States and the Netherlands. J. Gen. Intern. Med. 2003;18:335–342. doi: 10.1046/j.1525-1497.2003.10735.x. PubMed DOI PMC

Härter M., van der Weijden T., Elwyn G. Policy and Practice Developments in the Implementation of Shared Decision Making: An International Perspective. Z. Evidenz Fortbild. Qual. Gesundh. 2011;105:229–233. doi: 10.1016/j.zefq.2011.04.018. PubMed DOI

World Health Organization Charter for Health Promotion. Health Promot. Int. 1986;1:405. doi: 10.1093/heapro/1.4.405. DOI

Moreira T. The Transformation of Contemporary Health Care: The Market, the Laboratory, and the Forum. Routledge; New York, NY, USA: 2012.

Mead N., Bower P. Patient-Centredness: A Conceptual Framework and Review of the Empirical Literature. Soc. Sci. Med. 2000;51:1087–1110. doi: 10.1016/S0277-9536(00)00098-8. PubMed DOI

Say R., Murtagh M., Thomson R. Patients’ Preference for Involvement in Medical Decision Making: A Narrative Review. Patient Educ. Couns. 2006;60:102–114. doi: 10.1016/j.pec.2005.02.003. PubMed DOI

Ivankova N.V., Creswell J.W., Stick S.L. Using mixed-methods sequential explanatory design: From theory to practice. Field Methods. 2006;18:3–20. doi: 10.1177/1525822X05282260. DOI

Sharma A., Minh Duc N.T., Luu Lam Thang T., Nam N.H., Ng S.J., Abbas K.S., Huy N.T., Marušić A., Paul C.L., Kwok J., et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS) J. Gen. Intern. Med. 2021;36:3179–3187. doi: 10.1007/s11606-021-06737-1. PubMed DOI PMC

Demo-Geodemo Istituto Nazionale di Statistica Mappe, Popolazione, Statistiche Demografiche dell’ISTAT. Retrieved 1 December 2021. [(accessed on 10 October 2019)]. Available online: http://demo.istat.it/index.php.

Ridd M., Shaw A., Lewis G., Salisbury C. The Patient-Doctor Relationship: A Synthesis of the Qualitative Literature on Patients’ Perspectives. Br. J. Gen. Pract. J. R. Coll. Gen. Pract. 2009;59:e116–e133. doi: 10.3399/bjgp09X420248. PubMed DOI PMC

Mayring P., Fenzl T. Qualitative Inhaltsanalyse. In: Baur N., Blasius J., editors. Handbuch Methoden der Empirischen Sozialforschung. Springer Fachmedien; Wiesbaden, Germany: 2019. pp. 633–648.

Cocksedge S., Greenfield R., Nugent G.K., Chew-Graham C. Holding Relationships in Primary Care: A Qualitative Exploration of Doctors’ and Patients’ Perceptions. Br. J. Gen. Pract. 2011;61:e484–e491. doi: 10.3399/bjgp11X588457. PubMed DOI PMC

Peters S., Rogers A., Salmon P., Gask L., Dowrick C., Towey M., Clifford R., Morriss R. What Do Patients Choose to Tell Their Doctors? Qualitative Analysis of Potential Barriers to Reattributing Medically Unexplained Symptoms. J. Gen. Intern. Med. 2008;24:443. doi: 10.1007/s11606-008-0872-x. PubMed DOI PMC

Yang X., Parton J., Lewis D., Yang N., Hudnall M. Effect of Patient-Physician Relationship on Withholding Information Behavior: Analysis of Health Information National Trends Survey (2011–2018) Data. J. Med. Internet Res. 2020;22:e16713. doi: 10.2196/16713. PubMed DOI PMC

Sankar P., Jones N.L. To Tell or Not to Tell: Primary Care Patients’ Disclosure Deliberations. Arch. Intern. Med. 2005;165:2378–2383. doi: 10.1001/archinte.165.20.2378. PubMed DOI

Levy A.G., Scherer A.M., Zikmund-Fisher B.J., Larkin K., Barnes G.D., Fagerlin A. Prevalence of and Factors Associated With Patient Nondisclosure of Medically Relevant Information to Clinicians. JAMA Netw. Open. 2018;1:e185293. doi: 10.1001/jamanetworkopen.2018.5293. PubMed DOI PMC

Suchman A.L., Markakis K., Beckman H.B., Frankel R. A Model of Empathic Communication in the Medical Interview. JAMA. 1997;277:678–682. doi: 10.1001/jama.1997.03540320082047. PubMed DOI

Robinson J.W., Roter D.L. Psychosocial Problem Disclosure by Primary Care Patients. Soc. Sci. Med. 1999;48:1353–1362. doi: 10.1016/S0277-9536(98)00439-0. PubMed DOI

Teal C.R., Street R.L. Critical Elements of Culturally Competent Communication in the Medical Encounter: A Review and Model. Soc. Sci. Med. 2009;68:533–543. doi: 10.1016/j.socscimed.2008.10.015. PubMed DOI

Virlée J.B., Hammedi W., van Riel A.C.R. Healthcare Service Users as Resource Integrators: Investigating Factors Influencing the Co-Creation of Value at Individual, Dyadic and Systemic Levels. J. Serv. Theory Pract. 2020;30:277–306. doi: 10.1108/JSTP-07-2019-0154. DOI