Skip to main content
NCBI home page
Atencion Primaria logoLink to Atencion Primaria
. 2008 Sep 30;39(6):291–297. [Article in Spanish] doi: 10.1157/13106284

Teoría declarada de los médicos de familia sobre la relación con el paciente☆

Stated theory of family doctors on their relationships with patients

José Ramón Loayssa Lara a,⁎, Fermín González García b, Roger Ruiz Moral c
PMCID: PMC7664553  PMID: 17555660

Abstract

Objetivo

Identificar y analizar cuál es la «teoría» que los médicos de familia expresan sobre las características esenciales de la relación médico-paciente efectiva y funcional y sobre cómo alcanzarla (“teoría declarada» de Argyris y Schon).

Diseño

Cualitativo, basado en análisis de discursos.

Emplazamiento

Atención primaria.

Método

Entrevistas audiograbadas a 10 médicos de familia seleccionados por muestreo intencional que fueron transcritas. Se identificaron las proposiciones de los discursos y se construyeron mapas conceptuales. Se realizó un análisis inductivo mediante la categorización de los temas y posiciones aparecidos, y la identificación de similitudes y diferencias intersujetos.

Resultados

La confianza y la ausencia de conflictos son las principales características deseables de la relación médico-paciente. La actitud «demandante» y la deshonestidad de los pacientes son los obstáculos más citados. Se acepta la negociación pero se mantiene una visión muy limitada de la participación del paciente. Se aprecian diferencias en la distancia, el foco biomédico frente a psicosocial y en la educación sanitaria. Las habilidades de comunicación y las cualidades del médico son poco citadas. La terminología técnica en esta área aparece poco en los discursos.

Conclusiones

Los discursos resaltan el «consumismo sanitario» y descubren desacuerdos sobre la distancia en la relación y el abordaje psicosocial. Estos puntos, que deben ser priorizados en la formación, junto con la educación, pueden servir para definir distintas orientaciones profesionales de los médicos de familia. La metodología de la formación debe tener en cuenta que la experiencia domina en la «teoría declarada» en esta área.

Palabras clave: Relación médico-paciente, Medicina de familia, Estructura cognitiva, Mapas conceptuales, Investigación cualitativa, Entrevista

Footnotes

☆

Trabajo becado por el Departamento de Salud del Gobierno de Navarra.

Bibliografía

  • 1.Cohen-Cole S. Mosby Year Book, Inc; St. Louis: 1991. The medical interview: The three-function approach. [Google Scholar]
  • 2.Stewart M., Brown J., Galajda J., Meredith L., Sangster M. Evidence on patient-doctor communication. Cancer Prev Control. 1999;3:25–30. [PubMed] [Google Scholar]
  • 3.Blasi Z., Harkness E., Ernst E., Georgiou A., Kleijnen J. Influence of context effects on health outcomes: a systematic review. Lancet. 2001;357:757–762. doi: 10.1016/s0140-6736(00)04169-6. [DOI] [PubMed] [Google Scholar]
  • 4.Muñoz Alamo M., Ruiz Moral R., Pérula de Torres L. Evaluation of a patient-centred approach in generalized musculoskeletal chronic pain/fibromyalgia patients in primary care. Patient Educ Couns. 2002;48:23–31. doi: 10.1016/s0738-3991(02)00095-2. [DOI] [PubMed] [Google Scholar]
  • 5.Devine E., Cook T. A meta-analytic analysis of effects of psychoeducational interventions on length of post surgical hospital stay. Nurs Res. 1983;32:267–274. [PubMed] [Google Scholar]
  • 6.La Mónica E., Wolf R., Madea A., Oberst M. Empathy and nursing care outcomes. Sch Inq Nurs Pract. 1987;1:197–213. [PubMed] [Google Scholar]
  • 7.Williams S., Weinman J., Dale J. Doctor-patient communication and patient satisfaction: a review. Fam Pract. 1998;15:480–492. doi: 10.1093/fampra/15.5.480. [DOI] [PubMed] [Google Scholar]
  • 8.Mira J., Galdón M., García E., Velasco M., Lorenzo S., Vitaller J. ¿Qué hace que los pacientes estén satisfechos? Análisis de la opinión de pacientes y profesionales mediante la técnica Delphi. Revista de Calidad Asistencial. 1999;14:165–177. [Google Scholar]
  • 9.Wensing M., Jung H., Mainz J., Olesen F., Grol R. A systematic review of the literature on patient priorities for general practice care. Part 1: description of the research domain. Soc Sci Med. 1998;47:1573–1588. doi: 10.1016/s0277-9536(98)00222-6. [DOI] [PubMed] [Google Scholar]
  • 10.Haynes R., McDonald H., Garg A. Helping patients follow prescribed treatment. Clinical applications. JAMA. 2002;288:2880–2883. doi: 10.1001/jama.288.22.2880. [DOI] [PubMed] [Google Scholar]
  • 11.McDonald H., Garg A., Haynes R. Interventions to enhance patient adherence to medication prescription. Scientific review. JAMA. 2002;288:2868–2879. doi: 10.1001/jama.288.22.2868. [DOI] [PubMed] [Google Scholar]
  • 12.Ong L., De Haes J.C., Hoos A.M., Lammes F.B. Doctor-atient communication: a review of the literature. Soc Sci Med. 1995;40:903–918. doi: 10.1016/0277-9536(94)00155-m. [DOI] [PubMed] [Google Scholar]
  • 13.Hall J.A., Horgan T.G., Stein T.S., Roter D.L. Liking in the physician-patient relationship. Patient Educ Couns. 2002;48:69–77. doi: 10.1016/s0738-3991(02)00071-x. [DOI] [PubMed] [Google Scholar]
  • 14.Argyris C., Schön D. Jossey-Bass; San Francisco: 1974. Theory in practice. [Google Scholar]
  • 15.McFadden L., Seidman E., Rappaport J. A comparison of espoused theories of self and mutual help: Implications for mental health professionals. Prof Psychol Res Pr. 1992;23:515–520. [Google Scholar]
  • 16.Coté L., Leclére H. How clinical teachers perceive the doctorpatient relationship & themselves as role models. Acad Med. 2000;75:1117–1124. doi: 10.1097/00001888-200011000-00020. [DOI] [PubMed] [Google Scholar]
  • 17.Thistlethwaite J., Van der Vleuten C. Informed shared decision making: views and competencies of pre-registration house officers in hospital and general practice. Educ Gen Pract. 2004;15:83–92. [Google Scholar]
  • 18.Roter D.L., Larson S., Fisher G.S., Arnold R., Tulsky J.A. Experts practice what they preach. Arch Intern Med. 2000;160:3477–3485. doi: 10.1001/archinte.160.22.3477. [DOI] [PubMed] [Google Scholar]
  • 19.Argyris C., Schön D.A. Jossey-Bass; San Francisno: 1976. Theory in practice: increasing professional effectiveness. [Google Scholar]
  • 20.Argyris C., Putman R., Smith D.M. Jossey-Bass; San Francisco: 1987. Action science: concepts, methods and skills for research and intervencion. [Google Scholar]
  • 21.Pinies L., Novack J.D., Posner G.J., Vankirk J. Curriculum Series. Research Report 6. Cornell University; New York: 1978. The clinical interview: a method of evaluating cognitive structure. [Google Scholar]
  • 22.Novack J.D., Gowin D.B. Martínez Roca; Barcelona: 1988. Aprendiendo a aprender. 166-72. [Google Scholar]
  • 23.Rosser W.W., Kasperski J. The benefits of a trusting physician patient relationship. J Fam Pract. 2001;50:329–330. [PubMed] [Google Scholar]
  • 24.Briggs G.W. La alianza terapéutica: revisión de la relación médico-paciente. MEDIFAM. 1999;1:144–147. [Google Scholar]
  • 25.Ellsbury K.E., Montano D.E., Manders D. Primary care physicians attitudes about gatekeeping. J Fam Pract. 1987;25:616–619. [PubMed] [Google Scholar]
  • 26.Thom D.H., Campbell B. Patient-physician trust: an exploratory study. J Fam Pract. 1997;44:169–176. [PubMed] [Google Scholar]
  • 27.Timpka T., Hensing G., Alexanderson K. Dilemmas in sickness certification among Swedish physicians. Eur J Public Health. 1995;5:215–219. [Google Scholar]
  • 28.Tellness G. Sickness certification in general practice. A review. Fam Pract. 1988;6:58–65. doi: 10.1093/fampra/6.1.58. [DOI] [PubMed] [Google Scholar]
  • 29.Myerson S. Investigating stresess in general practice using an open ended approach in interviews. Fam Pract. 1990;7:91–95. doi: 10.1093/fampra/7.2.91. [DOI] [PubMed] [Google Scholar]
  • 30.McDonald P.S., O’Dowd J.C. The heartsink patient: a preliminary study. Fam Pract. 1991;8:112–116. doi: 10.1093/fampra/8.2.112. [DOI] [PubMed] [Google Scholar]
  • 31.Lamberts H., Janssens P.M.H. Defensive behavior by family practitioners. Ned Tijdschr Geneeskd. 1984;128:598–602. [PubMed] [Google Scholar]
  • 32.Wright E.B., Holcombe C., Salmon P. Doctors’ communication of trust, care, and respect in breast cancer: qualitative study. BMJ. 2004;328:864–870. doi: 10.1136/bmj.38046.771308.7C. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Leopolde N., Cooper J., Clancy G. Sustaining partnerships in primary care. J Fam Pract. 1996;42:129–133. [PubMed] [Google Scholar]
  • 34.Thom D. STS Physicians. Physician behaviors that predict patient trust. J Fam Pract. 2001;50:323–328. [PubMed] [Google Scholar]
  • 35.Wooley D., Clemens T. Family medicine residents’ and community physicians? Concerns about patients truthfulness. Acad Med. 1997;72:155–157. doi: 10.1097/00001888-199702000-00027. [DOI] [PubMed] [Google Scholar]
  • 36.Edwards N., Kornacki M.J., Silversin J. Unhappy doctors: what are the causes and what can be done? BMJ. 2002;324:835–838. doi: 10.1136/bmj.324.7341.835. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Smith R. Why are doctors so unhappy? BMJ. 2001;322:1074–1075. doi: 10.1136/bmj.322.7294.1073. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Mechanic D. Physician discontent: challenges and opportunities. JAMA. 2003;290:941–946. doi: 10.1001/jama.290.7.941. [DOI] [PubMed] [Google Scholar]
  • 39.Tomlin Z., Humphey C., Rogers S. General practitioners’ perceptions of effective health care. BMJ. 1999;318:1532–1535. doi: 10.1136/bmj.318.7197.1532. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Royal College of General Practitioners . RCGP; London: 1986. Working party The future general practitioner: learning and teaching. [Google Scholar]
  • 41.McCormick J. Croom Helm; London: 1979. The Doctor Father Figure or Plumber. [Google Scholar]
  • 42.Adleman R., Greene M., Charon R. Issues in physician-elderly patient interaction. Ageing Soc. 1991;11:127–148. [Google Scholar]
  • 43.Barry C.A., Bradley C.P., Britten N., Stevenson F.A., Barber N. Patients’ unvoiced agendas in general practice consultations: qualitative study. BMJ. 2000;320:1246–1250. doi: 10.1136/bmj.320.7244.1246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Law S., Britten N. Factors that influence the patient centredness of a consultation. Br J Gen Pract. 1995;45:520–524. [PMC free article] [PubMed] [Google Scholar]
  • 45.Ogden J., Andrade J., Eisner M., Ironmonger M., Maxwell J., Muir E. To treat? To befriend? To prevent? Patients’ and GPs’ views of the doctor's role. Scand J Prim Health Care. 1997;15:114–117. doi: 10.3109/02813439709018499. [DOI] [PubMed] [Google Scholar]
  • 46.Oliver C., González S., Martínez M.M. Factores relacionados con la satisfacción laboral y el desgaste profesional en los médicos de atención primaria de Asturias. Aten Primaria. 1999;24:352–359. [PubMed] [Google Scholar]
  • 47.Morrison I., Smith R. Hamster health care. BMJ. 2000;321:1541–1542. doi: 10.1136/bmj.321.7276.1541. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48.Starfield B. Is US health care really the best in the world? JAMA. 2000;284:483–485. doi: 10.1001/jama.284.4.483. [DOI] [PubMed] [Google Scholar]
  • 49.Brody H. Yale University Press; New Haven: 1992. The healers power. [Google Scholar]
  • 50.Anderson L.A., Dedrick R.F. Development of the trust in physician scale: a measure to assess interpersonal trust in patient-physician relationship. Psychol Rep. 1990;67:1091–1100. doi: 10.2466/pr0.1990.67.3f.1091. [DOI] [PubMed] [Google Scholar]
  • 51.Balint J., Shelton W. Regaining the initiative. Forging a new model of the patient-physician relationship. JAMA. 1996;275:887–891. doi: 10.1001/jama.275.11.887. [DOI] [PubMed] [Google Scholar]
  • 52.Orstein R., Sobel D. Simon & Schuter; New York: 1987. The healing brain. [Google Scholar]
  • 53.Astin J.A., Shapiro S., Eisenberg D., Kelly L., Forys M.A. Mindbody medicine: state of the science, implications for practice. J Am Board Fam Med. 2003;16:131–147. doi: 10.3122/jabfm.16.2.131. [DOI] [PubMed] [Google Scholar]
  • 54.Bucks R.S., Williams A., Whitfield M.J., Routh D.A. towards a typology of general practitioners attitudes to general practice. Soc Sci Med. 1990;30:537–547. doi: 10.1016/0277-9536(90)90152-i. [DOI] [PubMed] [Google Scholar]
  • 55.Huntington J. Allen & Unwin; London: 1983. Social work and general medical practice: collaboration or conflict? [Google Scholar]
  • 56.Calnan M. Images of general practice: the perceptions of the doctor. Soc Sci Med. 1988;27:579–581. doi: 10.1016/0277-9536(88)90005-6. [DOI] [PubMed] [Google Scholar]
  • 57.Merino Senovilla A., Miguel García F., Sanz Cantalapiedra R. Yo medicalizo, tu medicalizas, él... reflexiones y propuestas. AMF. 2005;1:269–278. [Google Scholar]
  • 58.Eraut M. Falmer Press; London: 1994. Developing professional knowledge and competence. [Google Scholar]
  • 59.Brookfield S.D. Open University Press; Milton Keynes: 1986. Understanding and facilitating adult learning. [Google Scholar]
  • 60.Robertson K. Reflection in professional practice and education. Aust Fam Physician. 2005;34:781–783. [PubMed] [Google Scholar]

Articles from Atencion Primaria are provided here courtesy of Elsevier

RESOURCES