title: Dynamics of doctor-patient relationship: A cross-sectional study on concordance, trust, and patient enablement.
abstract: BACKGROUND
  The rapid pace of medical advances coupled with specialization and super-specialization, is eroding the traditional doctor-patient relationship.
  
  
  OBJECTIVE
  (a) To study the determinants of core dimensions, such as, concordance, trust, and enablement in a doctor-patient relationship; (b) to explore associations, if any, among these core dimensions.
  
  
  METHODS
  A cross-sectional study design with both quantitative and qualitative methods was employed. One hundred and ninety-eight outdoor patients were interviewed as part of the quantitative study. Three dimensions of the doctor-patient relationship, that is, physician patient concordance, trust in physician, and patient enablement were assessed using validated tools. Focus group interviews using an open-ended format among few physicians was carried out as part of the qualitative study.
  
  
  RESULTS
  In the quantitative analysis most of the sociocultural factors did not show any significant association with the doctor-patient relationship. However, gender was significantly and strongly associated with trust in the physician. Female patients showed a much lower trust in the physician (50%) as compared to male patients (75%) (OR = 0.33, 95% CI 0.17 - 0.64, Chi Sq = 12.86, P = 0.0003). A qualitative study revealed language and culture, alternative medicines, commercialization of medicine, and crowding at specialist and super-specialist clinics as barriers to a good doctor-patient relationship. Better concordance was associated with improved trust in the doctor (OR = 5.30, 95% CI 2.06 - 13.98, Chi Sq = 14.46, P = 0.0001), which in turn was associated with improved patient enablement (OR = 3.89, 95% CI = 1.60 - 9.64, Chi Sq = 10.15, P = 0.001).
  
  
  CONCLUSIONS
  Good doctor-patient concordance (agreement) leads to better trust in the physician, which in turn leads to better patient enablement, irrespective of the sociocultural determinants.
authors.affiliation: Department of Community Medicine, D Y Patil Medical College, Pune, 411 018, India. amitavb@gmail.com
authors.forename: Amitav
authors.initials: A
authors.lastname: Banerjee
authors.forename: Debmitra
authors.initials: D
authors.lastname: Sanyal