INTRODUCTION

The term humanization, understood as the action of making something friendlier to humans, has started to be widely discussed in Brazilian medical schools, particularly since the implementation of the National Curricular Guidelines^1),(2. For many centuries, in medical education, the prioritization of the training of competent professionals in relation to the scientific knowledge of diseases was observed, to the detriment of the valorization of their humanistic competences related to patient-centered care^3)-(5.

In search of more effective ways to further the evolution of health services, attention has been paid to the need to reverse this scenario characterized by the dehumanization of medical care, or, at an earlier stage, the dehumanization of the care provided by the medical student, through the implementation of the teaching of humanistic skills inherent to the physician-patient relationship⁶.

It is known that the knowledge, skills, and attitudes, developed in actions of humanistic programs during medical undergraduate school, provide the training of future medical professionals who are more empathetic and able to organize their actions aiming to achieve better results in both diagnosis and therapy and in the disease prognosis^7),(8.

Among the strategies aimed at the teaching of humanization in medical undergraduate school, the continuous training of clinical methods centered on the patient and not only on the disease stands out. These methodologies include the development of the physician-patient relationship through the implementation of communication skills and understanding of the patient’s and family’s expectations, as well as the embracement and care attitudes provided by the entire health team⁹.

The objective of this article was to evaluate the attitudes of medical students regarding the physician-patient relationship.

METHODS

RESULTS

In the present study, 83 students were evaluated, aged between 18 and 30 years. In this sample, female students, those who declared a family income of less than US$ 2,140, those originated from the state capital Goiânia, and those who professed the Catholic religion prevailed. The majority of students reported not participating in student financial aid scholarship programs, or extracurricular and artistic activities; however, 81.9% of the students reported participating in activities related to undergraduate research activities (Table 1).

The majority of the students in the sample reported no personal history of severe diseases; however, in relation to family history, 50.2% reported a diagnosis in the family. It was also observed that children of parents who attended higher education prevailed in the sample, and 7.2% of the students had parents who had a medical degree. Regarding future areas of medical practice, 39.7% of the sample reported aptitudes for clinical specialties (Table 1).

According to the analysis of the scores on the PPOS scale, it was observed that students with physician-centered and disease-centered attitudes prevailed in the sample (85.5%). Similarly, it was found that the majority of students had low scores (mean scores <4.57) on questions related to the ‘caring’ domain (77.1%) and the ‘sharing’ domain (89.2%) (Table 2).

When considering the patient-centered communication model proposed by Epstein et al.¹³ (2005), there was a higher frequency of scores associated with moderately patient-centered attitudes (38.6%) in the area corresponding to sharing power and responsibility. It is noteworthy that the domains related to caring, both in the areas related to the understanding of the psychosocial context and the understanding of the patient’s perspective, showed mean PPOS scores higher than the sharing domain, with a prevalence of 8.4% of students who focused on humanized patient-centered attitudes (Table 2).

In the present study, male participants had higher mean scores than female ones, when analyzing the caring domain from the patient’s perspective (Δ= +0.46, p=0.011) (Table 3).

There were no statistically significant associations of PPOS scores among the variables age group, city of origin, carrying out undergraduate research activities, extracurricular internships, artistic activities, personal and family history of severe illness, and parental level of schooling (Table 3).

The caring domain of the PPOS scale showed a positive association (p=0.033) with the students’ family income in the studied sample, with the highest average score being observed among students with a family income between US$ 4,280 and US$ 8,560 (4.54) compared to those with an income lower than US$ 2,140 (4.19), between US$ 2,140 and US$ 4,280 (4.30), and greater than US$ 8,560 (4.00) (Table 3).

Students who reported not having a student grant for financial aid had higher PPOS scores in the present study than those who reported having a student grant, demonstrating a statistically significant association (Δ= +0.33, p=0.047) when evaluating this variable in relation to the caring domain, related to the understanding of the psychosocial context (Table 3).

The religion variable of the assessed sample showed a significant association between the categories of the PPOS scale (p=0.05). The caring domain in the understanding of the patient’s perspective, when associated with religion, indicated that 60.3% of the students with physician-centered attitudes and disease-centered attitudes were Catholic and 61.1% of those with moderately patient-centered PPOS scores (4.57 -4.99) declared to be evangelicals (p=0.005) (Table 4).

DISCUSSION

This study, carried out in a medical school, using the Problem Based Learning (PBL) teaching method, showed that the majority of the students (85.5%) still show physician-centered and disease-centered attitudes (mean PPOS scores< 4.57). This situation was also evidenced in other national and international studies^17)-(27.

The research carried out by Pereira⁷, PEIXOTO et al.²⁸, and Ribeiro et al.¹⁶ showed a prevalence of medical students with mean PPOS scores associated with moderately patient-centered attitudes (mean PPOS score: 4.57-4.99). This difference may be related to the sample size and the period of the course in which the students were enrolled, since the sample evaluated by the current study consisted of fourth-semester students and the other national studies analyzed students from different undergraduate periods. Ribeiro et al.¹⁶ and Ahmad et al.¹⁷ demonstrated that student scores at the end of undergraduate school tend to be positively associated with patient-centered attitudes.

When considering that the humanization of care can be achieved from the centralization of attention and care on the patient^9),(29, it is noteworthy that in the present study, the Patient-Practitioner Orientation Scale, translated and validated into Portuguese in Brazil and called EOMP, allowed an assessment of the humanized attitudes in medical care provided by medical students in relation to the domains of caring and sharing information with the patient^{7),(10),(11),(14}.

It should be noted that in this research, the scores related to the caring domain of the PPOS scale were higher than the scores of the sharing domain, as observed in previous national studies ^7),(16 and differing from the study by Dockens et al.¹⁸ carried out in Sweden, possibly because these countries have different socioeconomic and cultural aspects.

In several evaluated samples^{22),(23),(27),(28} the female sex showed a positive association with PPOS scores, as well as higher communication and empathy attitudes compared to males. However, in the current study, male participants paradoxically showed higher mean scores than females, with emphasis on the analysis of the caring domain from the perspective of the patient, showing a statistically significant difference (p≤0.05) between the genders in the study sample.

Although not described in previous national studies^27),(28, this study showed that the family income variable showed a positive association (p≤0.05) with the caring domain, as well as the variable related to having a student grant for financial aid with the caring domain according to the understanding of the patient’s psychosocial context. Students with a family income between US$ 4,280 and US$ 8,560 and those who declared not receiving a scholarship had the highest average scores.

For Jakovljevic³⁰, religion is seen as the search for meaning in complex and dynamic pathways related to the sacred; therefore it is recognized as part of the cultural context of the experience of the health-disease process. In the present study, and in the research by Vidal et al.²⁷, a positive association (p≤0.05) was observed between the religion variable and the mean PPOS scores related to patient-centered attitudes.

This study has limitations related to the self-reported data during the completion of the questionnaires, which may underestimate or overestimate the practical attitudes of humanization of care. In addition, the impossibility of establishing a relationship between cause and effect between dependent and independent variables is also described, due to the cross-sectional design of the study.

CONCLUSION

The current study showed that the medical students evaluated herein had attitudes physician-centered and disease-centered attitudes, with mean PPOS scores below the range related to attitudes towards humanized medicine. Variables such as gender, family income, student financial aid scholarship, and religion showed to be determinant factors of patient-centered attitudes.