The physician-patient interaction as perceived by individuals with severe disabilities.

Abstract

Very little has been written about the physician-patient interaction from the perspectives of individuals with severe disabilities. It has been reported that satisfaction with the physician-patient relationship can affect continuity of care and compliance with therapeutic regimens. While it is feasible that these issues could be of less consequence to the health of patients who are non-disabled, discontinuity of care or noncompliance with treatment plans could result in critical, life-threatening situations for individuals with severe disabilities. This study explored factors of the physician-patient interaction that are important from the perspective of individuals with severe disabilities. Research questions addressed the nature of the interaction, similarity with factors considered fundamental by individuals without disabilities, and whether there were factors important to individuals with severe disabilities that previously had not been reported in the patient satisfaction literature. The six individuals selected to participate in the study represented a range of disabilities that met the Rehabilitation Services Administration (RSA) criteria to be considered severe: blind, cerebral palsy, deaf, post-polio, spinal cord injured, and systemic lupus erythematosus. These participants also met all criteria as "key informants" for the purpose of qualitative research. A qualitative design was selected, employing two in-depth ethnographic interviews with each participant to elicit responses to focused, open-ended questions about the physician-patient interaction. The questions were patterned after those used in the development of the Smith-Falvo Patient-Doctor Interaction Scale (PDIS). Permission from the senior author was granted for "fair use" of the PDIS, and the related findings were used as comparison measures to responses of participants in this study. Findings of this research indicate that the interactional dynamics (eye contact, greeting, familiarity and evidence of respect) of first impressions for each individual in the physician-patient dyad influence to a large degree whether a satisfactory relationship can be established. In addition, participants with severe disabilities need to be considered by their physicians as equal partners in the management of their health care.