|Year : 2016 | Volume
| Issue : 1 | Page : 1-4
Patient-centeredness: A Comparison of Doctors' Orientation by Specialty in a Teaching Hospital in Nigeria
Tajudeen Abiola1, T Aminu Abdullahi2, Owoidoho Udofia3, Abubakar Baguda2, Zaharadeen G Habib4
1 Medical Services Unit, Federal Neuro Psychiatric Hospital, Barnawa-Kaduna, Kano, Nigeria
2 Department of Psychiatry, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Psychiatry, University of Calabar Teaching Hospital, Calabar, Nigeria
4 Department of Clinical Services, Federal Neuro Psychiatric Hospital, Kware-Sokoto, Nigeria
|Date of Web Publication||4-May-2016|
Dr. Tajudeen Abiola
Federal Neuro Psychiatric Hospital, Barnawa-Kaduna
Source of Support: None, Conflict of Interest: None
Context: There is a dearth of research on the orientations physicians bring into the patients physicians relationship in Nigeria. More scare was to find which specialty doctors were high on patient-centered care. To breach this gap, the study looked at doctors' orientation to patient-centeredness by specialty in Aminu Kano Teaching Hospital (AKTH), Kano, a major tertiary health institution in North-Western Nigeria. Aim: This study aimed to determine the range of patient-centeredness by medical specialty among doctors working in AKTH, Kano. Methods: This is a cross-sectional study in which 110 physicians representing eight medical specialties in AKTH, Kano-Nigeria filled the sociodemographic questionnaire and Patient-Practitioner Orientation Scale (PPOS). Statistical Analysis Used: Data collected were analyzed using IBM-SPSS 21 software using descriptive statistics to determine the frequency, cross-tabulations, means, and differences and Cronbach's alphas to assess the PPOS internal consistency. Result: The three topmost patient-centered oriented specialties on all the three outcome scores are psychiatry, obstetrics/gynecology, and maxillofacial/dental unit (in descending order). Conversely, the lowest orientations are noted for internal medicine and family medicine specialties. Specialties with medium patient-centered orientation are surgery, radiology, and pediatrics. Conclusion: Our results concluded that the most patient-centered medical specialty in the place of study is psychiatry. It argued that low mortality rate and the chronic care practice model might be contributory factors. Elucidating on other contributing factors should be one of the challenges of future studies.
Keywords: Doctors′ orientation, hospital, medical specialty, patient-centeredness
|How to cite this article:|
Abiola T, Abdullahi T A, Udofia O, Baguda A, Habib ZG. Patient-centeredness: A Comparison of Doctors' Orientation by Specialty in a Teaching Hospital in Nigeria. J Earth Environ Health Sci 2016;2:1-4
|How to cite this URL:|
Abiola T, Abdullahi T A, Udofia O, Baguda A, Habib ZG. Patient-centeredness: A Comparison of Doctors' Orientation by Specialty in a Teaching Hospital in Nigeria. J Earth Environ Health Sci [serial online] 2016 [cited 2022 Oct 3];2:1-4. Available from: https://www.ijeehs.org/text.asp?2016/2/1/1/181798
| Introduction|| |
Productive relationship between doctors and patients is a key clinical skill that entails expertise on both sides.  The doctors are expected to bring their clinical knowledge and skill to the service of the patients, , and the patients are to reciprocate by providing helpful information which should facilitate sound clinical engagement and care. , This interaction has been technically termed the patient-physician relationship, and the orientation the doctors bring into it can yield great outcomes or adverse effects.  Studies had shown that physicians' orientations that are patient-centered or mutualistic , typically bequeaths great effect in the patients physicians relationship. ,,, Such patient-centered care was based on qualities of patient's/family's values respect; collaborative care; given patient and family adequate health literacy; providing physical and emotional comfort for the patient; involvement of significant others in treatment; and health care should be accessible and continuous. 
Studies on the physicians' orientations to the patients physicians relationship are limited in Nigeria  unlike in Western Countries. ,,,, Further scarce was Nigerian study on physicians orientation towards active and collaborative engagement with patient and/or family. To contribute more studies to this important, yet little-researched phenomenon on Nigerian doctors' orientation to the patient's physicians relationship, this study hereby aimed to determine the most patient-centered specialty in Aminu Kano Teaching Hospital (AKTH), a major tertiary health institution in North-Western Nigeria.
| Methods|| |
Place of study
The research was conducted in AKTH, currently, a 500 bedded tertiary health care facility located in the North Western Nigeria. AKTH was about 350 beds as at the time of data collection in 2011 and comprised of 12 medical specialties of which one comprised of four subspecialties (i.e., pathology: Histopathology, haematology, histochemistry, and medical microbiology) and another one (dental/maxillofacial unit) has now been divided into dental surgery and maxillofacial unit. Ethical clearance was obtained from the ethical committee of AKTH-Kano.
All physicians from all medical specialties practicing in AKTH were invited to participate in the study. Of the 130 physicians contacted, 113 had analyzable data and represented 8 medical specialties. Of the 113 who filled our study instruments, three were house officers (i.e., medical interns) and were excluded in the final analysis. The unanalyzable data were either incompletely filled or completely filled but representing one physician for such unaccounted for specialties.
Participants filled two study instruments of a sociodemographic questionnaire and Patient-Practitioner Orientation Scale (PPOS). The PPOS was developed by Krupat et al. to measure the personal beliefs and preferences the doctors bring into the patients physicians relationship.  The PPOS has 18 items and measures three parameters of a "total" score and two subscores of "sharing" and "caring." The "total" score measure a range from patient-centered to doctor-centered. The first 9-item measures "sharing" which is a reflection of the extent to which the physician believes that patients desire information and should be part of the decision-making process along a shared control-doctor control continuum. The second 9-item measures "caring" on the extent to which the respondent sees the patient's expectations, feelings, and life circumstances as critical elements in the treatment process. Lower scores reflect an orientation toward a more doctor-centered relationship (high doctor control, focus on biomedical issues) whereas higher scores indicate preferences for a more patient-centered relationship (sharing control, focus on the whole person). This instrument is scored on a six-point likert scale ranging from "strongly agree" to "strongly disagree." Previous research outside Nigeria has shown that the PPOS has good reliability (α = 0.75-0.88) and validity. ,,, A study in Nigeria shows that PPOS has acceptable internal reliability for all the three outcome scores (Cronbah's alphas for "total," "sharing" and "caring" dimension of PPOS are respectively 0.733, 0.659 and 0.546). 
Data were analyzed using IBM-SPSS version 21 (released in 2012 by IBM Corp in Armonk, New York). Descriptive statistics were used to determine the frequency, cross-tabulations, means, and differences. Cronbach's alphas were used to assess the PPOS internal consistency. Significant was set at P < 0.05, two-tailed.
| Results|| |
[Table 1] reports the sociodemographic characteristics of the participants. More than two-third of the participants are aged 30 years and above, belong to the male gender and were also of the Islamic faith. More than three-fifth are married, and less than half have been practicing for over 6 years. The medical specialty with the highest number of participants is surgery (27.3%) followed by obstetrics and gynecology (20.9%) while psychiatry (4.5%) and maxillofacial/dental unit (3.6%) had the least number.
The Cronbach's alphas of the PPOS based on the "total," "sharing" and "caring" outcome scores are respectively 0.689, 0.637, and 0.414. The classification of participants based on their scores on the PPOS is shown in [Table 2]. Few number of the participants fall out of the low score range on the "total" (93.6%), "sharing" (77.3%) and "caring" (94.5%) distributions.
|Table 2: Respondents' distribution based on their Patient Practitioner Orientation Scale scores |
Click here to view
The participants' orientation reported in [Table 3] shows that the three top most patient-centered specialties on all the three outcome scores are psychiatry, obstetrics/gynecology, and maxillofacial/dental unit (in descending order). Conversely, the lowest patient-centered orientation scores are noted in Internal Medicine and Family Medicine specialties. Specialties with medium patient-centered orientation are surgery, radiology, and pediatrics.
| Discussion|| |
This report reflected orientations of doctors in AKTH by specialty to the practice of the patient-physician relationship. That psychiatry is the topmost specialty in this phenomenon appears not surprising considering that 45 min is the average duration a typical clerking takes compared to other specialties with far less duration. This lengthened duration comes with the expectation of self or formal training in communication skills implied in the application of Gorge Engels' biopsychosocial approach  to medical practice and being championed by Psychiatry. This shift in medical paradigm is one that identifies patient as the medical expert informant in his/her illness experience. ,,, In addition, the shift is one that mandatorily incorporates the patient's perspectives  into medical appreciation of patient needs and consequently leading to good quality of care  and great hospital image. , All these may be attesting to the negligible or nonexisting mortality rate typical witnessed in psychiatry practice in AKTH.  An insight experienced by providers of chronic care medical specialties like oncology. ,
All the above characteristics seemed to be shared by obstetrics/gynecology and maxillofacial/dental unit to a slightly less degree compared to psychiatry. That internal medicine and family medicine specialties appeared the least patient-centered might not be surprising considering the high mortality recorded in internal medicine at the place of study. , Family medicine mortality though often silence, are often lumped together with that of internal medicine reported deaths. This is because the most debilitated patients of the family medicine are admitted into medical wards and often died there.
A major strengthen of this study include it is not being a single specialty or primary care bases, like in previous studies looking specifically at either cancer care specialists  or primary care physicians.  Limitations include relatively small sample size, the omission of few other specialties (anesthesia, pathology [histopathology, hematology, histochemistry and medical microbiology], ophthalmology, and community medicine) in the place of study and nonexamination of mediating physician's factors such as prior training in communication skills, job satisfaction, and ethnic background. These limitations make our results generalization to other specialty and health institutions difficult.
| Conclusion|| |
This study contributed to the scare study on patient-physician relationship in Nigeria. Our results concluded that the must patient-centered medical specialty in the place of study (AKTH) is Psychiatry. It argued that low mortality rate and the chronic care practice model may be contributory factors. Elucidating on other contributing factors (e.g., communication skills) should be one of the challenges of future studies. Finally, we call for the inclusion of communication skill into the medical training in Nigeria. This should be at both the undergraduate and postgraduate levels to help bridge the patient-centeredness deficit gap.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Barry MJ, Edgman-Levitan S. Shared decision making - Pinnacle of patient-centered care. N Engl J Med 2012;366:780-1.
Dorr Goold S, Lipkin M Jr. The doctor-patient relationship: Challenges, opportunities, and strategies. J Gen Intern Med 1999;14 Suppl 1:S26-33.
Puri KB, Hall AD. Revision Notes in Psychiatry. 2 nd
ed. London: Arnold Publishers; 2004. p. 135.
Gupta A, Gupta N, editors. Step by Step Defence of Doctors. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2006.
Balint M. The Doctor, His Patient and the Illness. Edinburgh: Churchill, Livingstone; 1957. [Quoted in: Meza JP, Fahoome GF. The development of an instrument for measuring healing. Ann Fam Med 2008;6:355-60].
Gerteis M, Edgman-Levitan S, Daley J, Delbanco T. Through the Patient′s Eyes. San Francisco: Lossey-Bass; 1993.
Byrne PS, Long BL. Doctors Talking to Patients: A Study of the Verbal Behaviour of General Practitioners Consulting in their Surgeries. London: HMSO; 1976; In: Morgan M, editor. The Doctor-Patient Relationship. In: Scambler G, editor. Sociology as Applied to Medicine. 6 th
ed. Edinburgh, New York: Saunders/Elsevier; 2008. p. 55.
Chan CM, Azman WA. Attitudes and role orientations on doctor-patient fit and patient satisfaction in cancer care. Singapore Med J 2012;53:52-6.
Krupat E, Rosenkranz SL, Yeager CM, Barnard K, Putnam SM, Inui TS. The practice orientations of physicians and patients: The effect of doctor-patient congruence on satisfaction. Patient Educ Couns 2000;39:49-59.
Griffith S. A review of the factors associated with patient compliance and the taking of prescribed medicines. Br J Gen Pract 1990;40:114-6.
Wu C. The impact of brand image on service quality, patient satisfaction and loyalty. Afr J Bus Manage 2011;5:4873-82.
Abiola T, Udofia O, Abdullahi AT. Patient-doctor relationship: The practice orientation of doctors in Kano. Niger J Clin Pract 2014;17:241-7.
Richard LS Jr. Beliefs about control in the physician-patient relationship - Effect on communication in medical encounter. J Gen Intern Med 2003;18:609-16.
Lee KH, Seow A, Luo N, Koh D. Attitudes towards the doctor-patient relationship: A prospective study in an Asian medical school. Med Educ 2008;42:1092-9.
Engel GL. The need for a new medical model: A challenge for biomedicine. Science 1977;196:129-36.
Bensing JM, Verhaak PF, van Dulmen AM, Visser AP. Communication: The royal pathway to patient-centered medicine. Patient Educ Couns 2000;39:1-3.
Iliyasu Z, Abubakar IS, Gajida AU. Magnitude and leading causes of in-hospital mortality at Aminu Kano Teaching Hospital, Kano, Northern Nigeria: A 4-year prospective analysis. Niger J Med 2010;19:400-6.
Sani MU, Mohammed AZ, Bapp A, Borodo MM. A three-year review of mortality patterns in the medical wards of Aminu Kano Teaching Hospital, Kano, Nigeria. Niger Postgrad Med J 2007;14:347-51.
[Table 1], [Table 2], [Table 3]