Globally, the decades since 1990 have seen a change in the traditional doctor-patient relationship (DPR), especially in western societies. It is debatable if the change is an evolution, a metamorphosis or a simple shift. Historically, doctors often held god-like status for their healing hands and words, and patients trusted them unquestioningly. Contemporary life, however, has seen increasing healthcare privatization and control by profit-focused pharmaceutical and insurance companies. This has been accompanied by the establishment of consumer protection acts, laws regarding professional misconduct and criminal negligence, mass media increasing the public’s health awareness and the growth of patient forums in the virtual and real worlds (Shrivastava, Ramasamy, et al., 2014). Now too often busy doctors manage patients as ‘cases’ to which a set of certain rules and protocols are applied. And sadly, their patients are often very aware of their ranking as “case numbers”. However, some core values first set out by Hippocrates remain despite this changing DPR. 
Patient’s trust in the practitioner is vital. If there is no trust, the patient will not disclose complete information about his/her health situation, especially any delicate issues. Trust and distrust influence treatment satisfaction. Research shows that patients who take active part in their care plan discussions and have a feeling of trust throughout the whole treatment process, even when dealing with a team of specialists, have higher chances of satisfaction and better quality of life (Goold & Lipkin Jr., 1999).
Organised, patient-oriented elements where the patient feels like they are being heard, and where they encounter empathy and respect, are ideal for sharing all their concerns and developing a great therapeutic DPR (Goold & Lipkin Jr.). Culture and language differences between the health care professional (HCP) and patient are also an integral part of care. Culture influences effectiveness of communication. Where there is ethical or racial diversity, it is not rare for a patient from an ethnic minority background to prefer to see a doctor who is from a similar background, as it gives a feeling of connection, trust, and fellowship. (Warren J. Ferguson, 2002-5).
When it comes to culture, both HCP and patient bring their culture with them into the consultation room, and the differences that can arise are many e.g. belief in the scientific basis of disease encountering a belief in a spiritual or metaphysical cause of disease. In some cultures, some diseases are stigmatized e.g. mental illness or men complaining about pain, and hence both healthcare professional and patient face a lack of education about the topic and how to now introduce it into the conversation. [ Maureen Mayhew, 2018] Another example involves behaviors such as not answering questions or not maintaining eye contact might lead the unknowing HCP to reach an incorrect conclusion about the patient, and vice versa.
It is helpful if physicians and healthcare professionals overall have a concept of the community culture the patient is coming from, as many ethnic groups overall demonstrate certain trends. For example, it has been said that Caucasian Americans have a higher expectation of a prescription when they go to the doctor and more likely to be compliant. [Reference 2]. Meanwhile Africa Americans often have the church as pivotal in healthcare issues. In the Chinese culture, the behaviour of the individual can impact how the family as a whole is seen by the community and so there might be under-reporting of mental illness which is often perceived as a source of shame or guilt. Russia tends to have a more authoritarian relationship with healthcare providers and an ethnic Russian might not question a physician or fully share health issues. [7 ways culture influences healthcare, 2015].
There is also now a darker side to the changing HCP-patient culture. With the increased administrative tasks, rising patient-load and financial risk in medico-legal liability, HCP, including doctors, regularly face burnout. A recent survey among American physicians showed that 80% preferred communication with their patients to dealing with healthcare bureaucracy which takes time and energy away from paying proper attention to their patients (Brian Krans, 2017). And in some countries, doctors and nurses face increasing incidents of personal violence at the hands of patients or their relatives. This means that too often, HCP themselves exist in an environment that is not optimal for taking time to cross cultural divides and build trust. We can only hope that improvements in this are imminent.
Vocabulary exercise: Read the statements from the text. Change the word in bold to the form (noun, verb, adjective, adverb) given in brackets.
Skills: Vocabulary building
Remember: noun = thing; verb = action word; adjective = used to describe nouns; adverbs = used to describe verbs
What is the verb form of this word? ______________________
What is the verb form of this word? ______________________
What is the verb from of this word? _______________________
What is the noun form of this word? ______________________
What is the adverb form of this word? __________________________
What is the noun form of this word? _______________________
What is the adjective form of this word? ___________________________
What is the adjective form of this word? ____________________________
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