. 2012 Feb 8;18(1):15–31. doi: 10.1007/s10459-012-9352-5

Table 2.

Clinical settings characteristics in a Southeast Asian teaching hospital that influenced doctor–patient communication

Clinical settings characteristics	Doctors’ statements	Low educated patients’ statement	High educated patients’ statement	Literature on specific context
Lack of role model in partnership communication with patient	“This is the model of an old fashioned teacher: what do you feel? Oh okay, this is the medicine.’ A direct and short communication” (Doctor 6: A third year resident)	“A good doctor? Doctor A treats me like this … Doctor B treats me like that … Doctor C treats me …” (Patient 9: a low-educated patient)	“That is the role-model, it may mislead the students about proper communication with patients!” (Patient 13: a high-educated patient)	The model described by the resident is a typical model of a traditional doctor from the past. The low-educated patient cannot describe what a good doctor is. The high-educated patient explained that this may be the wrong model to establish a good doctor–patient relationship. From their experiences, both patients have difficulty in describing which example is ideal. Lack of role-model of ideal doctor–patient communication is typical in the context of the study. Role-model is one of the important educational tools
Lack of participation of students in patient-care	“I explained to student A that Mr. X (whom I examined just now) is having chronic obstruction pulmonary dysfunction. Then I ask Mr. X that I think he understand my explanation” (Doctor 3: a third year resident)	“The doctor already explained the disease to the young doctor. Well, I do not dare ask anymore questions” (Patient 2: a low educational level)	“That doctor did not talk to me. He talked to the student. When he said okay, I do not think he meant me. I demand further explanation” (Patient 11: a high educational level)	In the context of this study we already knew that students do not participate in patient-care. Students only observe. This clinical education system that is adhered to the unmanaged health care system begun to create confusion for the residents and the patients. No one was sure who is talking to whom. Participation in patient-care is the key for successful clinical education
Traditional agrarian-culture (Doctor 15: an internist with 5 years’ experience)	“I always inspect whether the residents or my students are ready or not in the clinic. Nowadays at 9 o’clock am they are ready. It is good!”	“It is usually like that. I came at 6 o’clock in the morning to queue up. I usually meet the doctor in the afternoon. That is common isn’t it? Well, after waiting for hours, sometimes I forget what to say …” (Patient 7: a low-educational level)	“The clinics open at 8 am. But we are never sure when the doctor will come. We wait for hours but we only meet the doctor for 5 min. What kind of detailed story can be presented then?” (Patient 16: a high-educational level)	One of non-western philosophy is to be calm, they do not targeting anything. This is typical of a traditional agrarian-society when harvest is unpredictable. Doctors still adhere to this kind of traditional agrarian behavior. Amplified by the unmanaged health care-system. The low-educated patient has internalized this unaccepted behavior into something that “common”. The high-educated patient articulates that they do not agree at all. Both patients are unsatisfied

Clinical settings characteristics

Doctors’ statements

Low educated patients’ statement

High educated patients’ statement

Literature on specific context

Lack of role model in partnership communication with patient

“This is the model of an old fashioned teacher: what do you feel? Oh okay, this is the medicine.’ A direct and short communication”

(Doctor 6: A third year resident)

“A good doctor? Doctor A treats me like this … Doctor B treats me like that … Doctor C treats me …”

(Patient 9: a low-educated patient)

“That is the role-model, it may mislead the students about proper communication with patients!”

(Patient 13: a high-educated patient)

The model described by the resident is a typical model of a traditional doctor from the past. The low-educated patient cannot describe what a good doctor is. The high-educated patient explained that this may be the wrong model to establish a good doctor–patient relationship. From their experiences, both patients have difficulty in describing which example is ideal. Lack of role-model of ideal doctor–patient communication is typical in the context of the study. Role-model is one of the important educational tools

Lack of participation of students in patient-care

“I explained to student A that Mr. X (whom I examined just now) is having chronic obstruction pulmonary dysfunction. Then I ask Mr. X that I think he understand my explanation”

(Doctor 3: a third year resident)

“The doctor already explained the disease to the young doctor. Well, I do not dare ask anymore questions”

(Patient 2: a low educational level)

“That doctor did not talk to me. He talked to the student. When he said okay, I do not think he meant me. I demand further explanation”

(Patient 11: a high educational level)

In the context of this study we already knew that students do not participate in patient-care. Students only observe. This clinical education system that is adhered to the unmanaged health care system begun to create confusion for the residents and the patients. No one was sure who is talking to whom. Participation in patient-care is the key for successful clinical education

Traditional agrarian-culture

(Doctor 15: an internist with 5 years’ experience)

“I always inspect whether the residents or my students are ready or not in the clinic. Nowadays at 9 o’clock am they are ready. It is good!”

“It is usually like that. I came at 6 o’clock in the morning to queue up. I usually meet the doctor in the afternoon. That is common isn’t it? Well, after waiting for hours, sometimes I forget what to say …”

(Patient 7: a low-educational level)

“The clinics open at 8 am. But we are never sure when the doctor will come. We wait for hours but we only meet the doctor for 5 min. What kind of detailed story can be presented then?”

(Patient 16: a high-educational level)

One of non-western philosophy is to be calm, they do not targeting anything. This is typical of a traditional agrarian-society when harvest is unpredictable. Doctors still adhere to this kind of traditional agrarian behavior. Amplified by the unmanaged health care-system. The low-educated patient has internalized this unaccepted behavior into something that “common”. The high-educated patient articulates that they do not agree at all. Both patients are unsatisfied