The Doctor-Patient Relationship and Type 2 Diabetes: What Can We Learn from a Cross-National Comparison of Three Qualitative Datasets?

Background: Evidence suggests that higher levels of patient involvement results in more beneficial care. Patient involvement can be higher in long term conditions, such as type 2 diabetes, where self-management is important. But we need to better understand what happens in the shared decision process and which factors contribute to the inherent inequalities. In this paper, we explore models of doctor patient relationship in three qualitative datasets from Germany, Spain and the UK. The data were originally collected to explore the experiences of patients with type 2 diabetes. Lay summaries are published at www.krankheitserfahrungen.de, http://www.dipex.es, www.healthtalkonline.org.

Methods: A secondary analysis of the datasets using a two strand approach. First, a thematic analysis of the individual datasets to identify models of doctor patient relationships, and examine what factors may contribute to these models. Second, a comparison of these findings to identify similarities or differences across the datasets in order to enhance our understanding of shared decision making.

Results: Early analysis suggests the importance of a trust within the doctor-patient-relationship and an enduring paternalistic model in the management of diabetes. While UK patients may suggest some partnership working in the way they articulate their self-management, in practice, they do what the doctor tells them. In contrast, German participants emphasize a desire to preserve a certain level of autonomy. This was most obvious with eating and weight management, where participants reported enjoying pleasures that their GPs regarded as unhealthy. Several Spanish interviewees experienced some lack of control from their professionals and felt their treatment was routine rather than an individually tailored process.

Conclusions: While management recommendations of diabetes are largely standardized, patient experience and expectations may differ according to cultural and national peculiarities. Interestingly, a paternalistic model is not necessarily experienced as a contrast to self-management.