Analysis of explanatory models and therapeutic choices under patient-provider power relation context

Abstract

Both physicians and patients have their own explanatory model, "the notion about an episode of sickness and its treatment that is employed by all those engaged in the clinical process". The difference of explanatory models between physicians and patients is the significant factor causing negative relationship and unsuccessful therapeutic outcomes in the long run. The purpose of this study was to examine and contextualize explanatory models and therapeutic choices under patient-provider power relationship. A field study was conducted at the out-patient service of the general practice and the medicine departments in one of tertiary hospitals in the Northeast region of Thailand during December 2003 till January 2004. In the process of data collection, the research took the participant-as-observer role to observe 455 medical consultations from 8 physicians and 452 patients, and then 18 selected patients were followed for in-depth interview. The result showed that during medical consultations physicians' power dominated that of patients. This study has conceptualized "the chamber of power sharing" model to describe the exchange of explanatory models between patient and physicians in each relation. The model pointed out that during the consultation session, a chamber of power sharing was formed. In case of the physicians' power relation, this chamber was mostly filled with the physician's explanatory models, since it was used as the significant source of power and prescription was written out of this explanatory model with limited input or exchange from the patient's explanatory model. Patients then equalized the imbalanced explanatory model in the chamber of power sharing by exercising their explanatory models after medical consultation on therapeutic choices by not following what physicians ordered. The results suggested that patients would find their ways to utilize their power in practicing illness behaviors. The effective exchange of explanatory models under the proper role and relation between patients and providers was concluded as the solution to achieve better quality of care