Empirical analysis of professional-patient role asymmetry in two rehabilitation centres : evidence of a lag between societal trends and professional response

Demographic shifts and changes in society's beliefs and values are challenging the traditional professional-patient relationship in rehabilitation, where professional dominance is entrenched in the institution. Since this interaction underlies much of the utilization of health services, with the ensuing costs and benefits of concern to the professional, patient and third parties, such as patients' families and governments as the bill-payers, it undergoes ongoing scrutiny by both the public and governments. It is important then to assess the professional's response to the challenge. With the future directions of the challenge, and the lagging response, unknown, the implications of the response are obscured. The professional's response to the patient's challenge to professional authority was examined through role interaction between the professional and patient. Whereas, traditionally, professionals believe they make health decisions through the application of their expertise, it was hypothesized that how the professional explained, described and dealt with the patient was predicted to be dependent on the interaction between professional role and patient role when the decision concerned the responsibility for making decisions. Questionnaires and interviews were given to thirty-nine professionals --physicians, physiotherapists, occupational therapists, nurses, and social workers — at G.F. Strong and Holy Family Hospitals. The questionnaire measured the professional's role as a 'controller' (believes that the professional should assume the responsibility for health decisions) or 'accommodator' (believes that the patient should assume responsibility for health decisions). The patient's role, presented to these professionals in the interview, was fabricated in two case studies in which the patient's behavior was consistent with that of a 'consumer' (wishes to assume the responsibility for health decisions) or a 'traditional dependent' patient (wishes the professional to assume responsibility for health decisions). In the interaction between the professional and each of the patient roles, the patient was reported to disagree with the professional's decision. In this context, the professional was asked to explain, describe and deal with the patient's behavior. The interaction between professional role and patient role was assessed by two-way analysis of variance. The hypothesis was supported for the dimensions of describing and dealing but not for explaining. It was concluded that this provided preliminary evidence that role interaction systematically explained, in part, the professional's response to challenge to the traditional professional-patient relationship. The traditional professional role was considered as evidence of resistance to the challenge. The implications of the resistance were considered in terms of four scenarios which combined 1) the future direction of the trend of 'challenge', that is to increase or decrease, and 2) the direction of the professional's resistance, that is to increase or decrease. The options following from the interaction between directions included 1) return to the status quo, that is professional dominance in the institution; 2) accommodation of the challenge, that is, patient dominance; and conflict when, 3) professional and patient fight to determine who is in charge, and 4) neither the professional nor patient take charge. It was recommended that 1) researchers develop additional studies to further define the situation and to monitor the direction of the trends; and 2) that professionals and the institution, a) redefine the traditional concepts such as 'team' and the obligations and responsibilities of the professional and patient, and b) discuss, in a public forum, the direction in which the trends should go, and the interventions that would best direct them.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat