The process of medical mediation involves the reconstruction of doctor-patient relationships through sharing mutual truthful information and encouraging dialogue between doctors and their patients. This study was designed to examine the effects of disclosing the avoidable as well as unavoidable causes of doctors' behavior following malpractice or perceived inconsiderate behavior on patients' feelings in medical mediation. An avoidable cause was defined as doctor's behavior that was incautious or showed insufficient empathy. An unavoidable one, however, was defined as any cause other than doctors' behavior. A questionnaire was administered to 385 Japanese hospital outpatients, in which participants were presented a range of scenarios with the above two causes for doctor's behavior or an adverse event. Participants' feelings toward the doctor in each scenario were measured on a seven-point scale following disclosure of each cause. The five scenarios provoking negative feelings toward doctors involved "(the patient) being ignored," "refusal of a request," "dominating behavior," "a minor incident," and "an adverse event." The valid response rate was 62.9% (242/385). Negative feelings were evoked in all five scenarios. After disclosure of avoidable causes, scores for negative feelings significantly increased between 3% and 33%. In contrast, after disclosure of unavoidable causes, scores for negative feelings significantly decreased between 11% and 43%. These findings imply that disclosure of causal information in medical mediation will provide the opportunity to reevaluate unexpected doctors' behavior and change patients' negative feelings. Therefore, disclosures should be made in the case of not only unavoidable causes but also avoidable ones.
Background: In medical practice, a relationship of trust between doctors and patients is essential. An important part of building and maintaining this relationship is empathy. Prior studies have suggested that empathy in medical students declined around the fourth year. The purpose of this study is to verify the decrease of empathy and gain further insights into empathy factors. Methods: This longitudinal study of undergraduate medical students was conducted through a self-administered, 20-item survey, using a 5-point Likert scale. First (n=105) and fourth (n=62) year students at Yamagata University Faculty of Medicine, School of Medicine in Japan were assessed for empathy using the Japanese version of the Jefferson Scale of Physician Empathy (JSPE). Total empathy scores were calculated, and multivariate analysis of variance (MANOVA) was used to reveal the underlying factors of the Japanese version of JSPE. Finally, logistic regression analysis was used to investigate the presence of any relationships between attributes such as gender-related differences, age, school year, and experience as a patient. Results: In total, 234 participants were contacted, of whom 167 responded (71.3%). No decrease of mean empathy scores was shown between first-year (66.4) and fourth-year students (68.4). Factor analysis identified four factors: “building good patient-doctor relationship,” “importance of empathetic care,” “understanding patients’ view,” and “compassionate care.” A weak correlation (r = - 0.271) was observed between “understanding patients’ view” and “importance of empathetic care.” The odds ratio of females in “understanding patients’ view” and “compassionate care” was significantly higher (p<0.05) than in males. For “compassionate care,” statistically significant differences were noted for gender (p < 0.05) and age (p< 0.05) and the effect of gender being larger than age. Conclusions: This longitudinal cohort study in one medical school in Japan showed that empathy scores of first- and fourth-year students did not decrease, and the contribution of “compassionate care” was lowest of the four factors. The results imply the necessity to provide a program that enables preclinical medical students to understand the significance of emotional empathy and express it before they appear for computer-based testing (CBT) and objective structured clinical examination (OBCE) in their fourth year.
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