Attitudes towards the doctor-patient relationship: a prospective study in an Asian medical school

Med Educ. 2008 Nov;42(11):1092-9. doi: 10.1111/j.1365-2923.2008.03157.x. Epub 2008 Sep 26.


Context: Patient-centredness is an accepted guiding principle for health system reform, patient care and medical education. Although these attitudes are strongly linked with cultural values, few studies have examined attitudes towards patient-centredness in a cross-cultural setting.

Objectives: This prospective study evaluated attitudes towards patient-centredness in a cohort of Asian medical students and examined changes in these attitudes in the same students on completion of their junior clinical clerkships.

Methods: The study was conducted in a cohort of 228 medical students entering Year 3 in medical school. The Patient-Practitioner Orientation Scale (PPOS), a validated instrument which scores an individual's level of patient-centredness, was used.

Results: Being female and having personal experience of continuing care were significantly associated with higher scores. Students in the USA were previously reported to have similar 'caring' but higher 'sharing' scores on the same scale. At the end of the junior clinical clerkship, there were improvements in the 'caring' subscale, but no change or a reduction in 'sharing'. Students who did not have previous personal experience with continuing care experienced a greater increase in overall PPOS score.

Conclusions: When compared with students in the USA, the students in our study appear to have a lower propensity to view the doctor-patient relationship as a partnership. This may be a reflection of differences in cultural norms and expectations of doctor-patient interaction in different societies. Our finding that attitudes towards patient-centredness did not decline over the course of the year, which contrasts with findings of other studies, may be attributed to various factors and warrants further study.

MeSH terms

  • Attitude of Health Personnel*
  • Clinical Clerkship*
  • Female
  • Humans
  • Male
  • Patient-Centered Care*
  • Physician-Patient Relations*
  • Prospective Studies
  • Singapore
  • Students, Medical / psychology*
  • Young Adult