Doctor-patient interaction in Finnish primary health care as perceived by first year medical students.
BACKGROUND
In Finland, public health care is the responsibility of primary health care centres, which render a wide range of community level preventive, curative and rehabilitative medical care. Since 1990's, medical studies have involved early familiarization of medical students with general practice from the beginning of the studies, as this pre-clinical familiarisation helps medical students understand patients as human beings, recognise the importance of the doctor-patient relationship and identify practicing general practitioners (GPs) as role models for their professional development. Focused on doctor-patient relationship, we analysed the reports of 2002 first year medical students in the University of Kuopio. The students observed GPs' work during their 2-day visit to primary health care centres.


METHODS
We analysed systematically the texts of 127 written reports of 2002, which represents 95.5% of the 133 first year pre-clinical medical students reports. The reports of 2003 (N = 118) and 2004 (N = 130) were used as reference material.


RESULTS
Majority of the students reported GPs as positive role models. Some students reported GPs' poor attitudes, which they, however, regarded as a learning opportunity. Students generally observed a great variety of responsibilities in general practice, and expressed admiration for the skills and abilities required. They appreciated the GPs' interest in patients concerns. GPs' communication styles were found to vary considerably. Students reported some factors disturbing the consultation session, such as the GP staring at the computer screen and other team members entering the room. Working with marginalized groups, the chronically and terminally ill, and dying patients was seen as an area for development in the busy Finnish primary health care centres.


CONCLUSIONS
During the analysis, we discovered that medical students' perceptions in this study are in line with the previous findings about the importance of role model (good or bad) in making good doctors. Therefore, medical students' pre-clinical primary health care centre visits may influence their attitudes towards primary health care work and the doctor-patient relationship. We welcome more European studies on the role of early pre-clinical general practice exposure on medical students' primary care specialty choice.
Miettola
Juhani
J
Department of Public Health and General Practice, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland. juhani.miettola@uku.fi
Mäntyselkä
Pekka
P
Vaskilampi
Tuula
T
D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D002983:Clinical Competence; D003142:Communication; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005387:Finland; D006801:Humans; D008611:Mentors; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology* / Q000592:standards; D011216:Practice Management, Medical; D011320:Primary Health Care / Q000592:standards*; D015397:Program Evaluation; D012938:Social Perception; D013337:Students, Medical / Q000523:psychology*