Doctor authority in the doctor-patient relationship

<p dir="ltr">This thesis explored one of the important but previously neglected aspects of doctor-patient relationships that has a significant effect on treatment outcomes and patients’ well-being – the authority of a doctor. The concept of authority has been a subject of research in various settings from several branches of science, including political science, psychology, and education. Although a doctor’s authority is always present in doctor-patient communication, it may take different forms, oscillating between an authoritarian and an authoritative style.</p><p dir="ltr">Across many years of medical history, therapies were focused on eliminating external invaders causing a disease. Patients’ emotions were not considered to be contributors to the course of an illness. Research emerging in the second half of the 19th century demonstrated that patients played an essential role in the success of medical intervention. Doctor-patient communication is primarily guided by doctors and affects patients’ emotional state, which in turn impacts treatment outcomes.</p><p dir="ltr">This thesis used a sequential exploratory mixed methods approach, starting with an extensive conceptual exploration of the doctor-patient relationship, followed by three empirical studies. The aim of this thesis was to explore the sources of doctors’ authority and then build and validate a scale depicting different expressions of doctors' authority – the Authoritarian-Authoritative (A-A) Doctor Communication Scale.</p><p dir="ltr">In the first part of this thesis, the conceptual analysis approach was employed to examine the main drivers and unique aspects of the doctor-patient relationship, focusing on imbalanced power relationships in the medical context and beyond. The purpose of the first empirical study, Study 1, was to identify underlying factors driving doctors’ communication styles.</p><p dir="ltr">Study 1 utilised a semantic differential survey. The aim of the second empirical study, Study 2, was to examine patient preferences within the authoritarian-authoritative domain identified by Study 1 and develop a validated assessment tool. A focus group interview complementing Study 1 and Study 2 by exploring the reasons behind patient preferences constituted Study 3.</p><p dir="ltr">Study 1 (n=314) and Study 2 (n=118) confirmed the validity of both the underlying concept of authority and the novel A-A Doctor Communication Scale in its application to GP-patient relationships. In the patient preference study, respect, discussion, and thorough explanation were the most important features of the doctor's communication valued by respondents, while remembering their names was not considered very important. Overall results indicated that patients preferred authoritative doctors and valued friendliness and respect out of the authoritative behavioural range the most. The focus group added insights into information needs and trust.</p><p dir="ltr">The A-A Doctor Communication scale can be used in future studies of doctor-patient interactions. The interpretation of the results of the empirical studies led to the counterintuitive conclusion that sharing power in an authoritative manner strengthened a GP’s power rather than reduced it. In addition, the A-A Doctor Communication Scale seemed to provide an underlying theoretical construct for the shared decision-making (SDM) paradigm. The scale could be useful for overcoming barriers to SDM implementation.</p>