Medical empathy in the physician-patient relationship: A review from a cultural perspective / La empatía médica en la relación médico-paciente: Una revisión desde una perspectiva cultural

BACKGROUND: Medical empathy is a fundamental pillar in the social construction of the physician-patient relationship. In this light, patients' beliefs and perceptions of medical empathy, and physicians' empathic attitudes towards their patients are guided by their socio-cultural understandings and expectations, which naturally vary from culture to culture. Such considerations are particularly relevant to the field of social psychology and to public healthcare systems where a growing number of foreign physicians characterise their highly diverse socio-demographic makeup. However, there is no clear research agenda concerning the way in which medical empathy should be investigated from a cultural point of view in years to come. AIM: To this end, the paper presents a systematic review of studies that examines medical empathy in healthcare contexts from a cultural perspective to synthesize their findings, evaluate their limitations and propose future lines of research. Material and Methods: The review considers articles published from January 2010 to June 2022 in the PubMed, Scopus and Web of Science databases and follows the PRISMA methodology. RESULTS: Three studies, of the 314 articles analysed, met the criteria established for this investigation. The analysis shows that research on medical empathy has analysed the cultural diversity of physicians of a limited range of cultural backgrounds, exclusively from a cross-cultural perspective, employing quantitative research designs and exclusively using the Jefferson Medical Empathy Scale. Conclusions: We suggest that future studies adopt an intercultural perspective of medical empathy as a psychocultural construct rather than as merely a sociocultural one.

ANTECEDENTES: La empatía médica es un pilar fundamental en la construcción social de la relación médico-paciente. En este sentido, las creencias y percepciones de los pacientes sobre la empatía médica y las actitudes empáticas de los médicos hacia sus pacientes están guiadas por sus entendimientos y expectativas socioculturales, que naturalmente varían de una cultura a otra. Tales consideraciones son particularmente relevantes para el campo de la psicología social y para los sistemas públicos de salud donde un número creciente de médicos extranjeros caracterizan su composición sociodemográfica altamente diversa. Sin embargo, no existe una agenda de investigación clara sobre la forma en que la empatía médica debe investigarse desde un punto de vista cultural en los próximos años. OBJETIVO: Para ello, el artículo presenta una revisión sistemática de estudios que examinan la empatía médica en contextos sanitarios desde una perspectiva cultural para sintetizar sus hallazgos, evaluar sus limitaciones y proponer futuras líneas de investigación. Materiales y Métodos: La revisión considera artículos publicados desde enero de 2010 hasta junio de 2022 en las bases de datos PubMed, Scopus y Web of Science y sigue la metodología PRISMA. RESULTADOS: Tres estudios, de los 314 artículos analizados, cumplieron con los criterios establecidos para esta investigación. El análisis muestra que la investigación sobre la empatía médica ha analizado la diversidad cultural de los médicos de una gama limitada de antecedentes culturales, exclusivamente desde una perspectiva transcultural, empleando diseños de investigación cuantitativos y utilizando exclusivamente la escala de empatía médica de Jefferson. Conclusiones: Sugerimos que los estudios futuros adopten una perspectiva intercultural de la empatía médica como una construcción psicocultural en lugar de una meramente sociocultural.

Instrumentos estandarizados para medir la relación médico-paciente: una revisión sistemática de la literatura internacional e iberoamericana / A systematic review of standardized instruments to measure the doctor-patient relationship

The current health situation caused by the COVID-19 pandemic has prompted a reconfiguration of the doctor-patient relationship. We performed a systematic review to comparatively evaluate the instruments most used to study communication in the doctor-patient relationship. We identified 43 instruments assessing different aspects of the doctor-patient relationship, of which 34 correspond to Anglo-Saxon literature and nine to Latin American texts. The psychometric evidence for many of these instruments is incipient. Most of these instruments contemplate a unidirectional design and address similar dimensions of the doctor-patient relationship, particularly in the Latin American context where the relationship is mostly studied in a unidimensional way. We propose recommendations for the development, revision, or refinement of instruments that measure communication in the doctor-patient relationship.

General health and perceived/feared discrimination in the lgbt+ community / Saúde geral e discriminação percebida e temida na comunidade lgbt+ / Salud general y discriminación percibida y temida en la comunidad lgbt+

ABSTRACT Objective: to analyze the relationship of perceived and feared discrimination with general health in LGBT+ people according to schooling level, gender identity and socioeconomic level. Method: a cross-sectional and correlational study was conducted. The sample consisted of 120 participants of legal age from the Maule region (Chile) who belonged to the LGBT+ community and answered an online survey due to the SARS-CoV-2 pandemic. The survey also included an open question for the participants to share discrimination experiences regarding the treatment received from the Nursing personnel. The quantitative data were examined by means of descriptive and inferential analyses (means difference and correlation tests). The results extracted were analyzed following the thematic and discursive analysis techniques. Results: although perceived discrimination had low prevalence in the sample, 44.17%, 38.33% and 32.51% manifested fear of not being loved, of not finding a job and of being rejected by their family for being part of the LGBT+ community, respectively. Likewise, discrimination was higher in the group of trans people and was mainly reflected in unjustified dismissals, difficulties finding a job or ill-treatment in the provision of health services. Finally, it was found that the participants exposed to more discrimination also reported worse general health. Conclusions: discrimination is a problem that affects the LGBT+ community, particularly the trans collective. The severe implications of discrimination for people's health evidence the need to design strategies, policies and regulations aimed at fostering tolerance and integration.

RESUMO Objetivo: analisar a relação entre a discriminação percebida e temida e a saúde geral das pessoas LGBT+ de acordo com seu nível educacional, identidade de gênero e nível socioeconômico. Método: realizou-se um estudo transversal e correlacional. A amostra foi composta por 120 participantes adultos da região de Maule (Chile), pertencentes à comunidade LGBT+, que responderam a uma pesquisa virtual devido à pandemia de SARS CoV-2. A pesquisa também incluiu uma pergunta aberta que proporcionou um espaço para os participantes compartilharem experiências de discriminação em relação ao tratamento recebido da equipe de enfermagem. Os dados quantitativos foram examinados por meio de análises descritivas e inferenciais (testes de diferença de médias e correlações). As histórias extraídas foram analisadas segundo técnicas de análise temática e discursiva. Resultados: embora a discriminação percebida tenha uma baixa prevalência na amostra, 44,17% expressaram medo de não serem amados, 38,33% de não encontrar emprego e 32,51% de serem rejeitados pela família por fazerem parte da comunidade LGBT+. Da mesma forma, a discriminação foi maior no coletivo de pessoas trans e se refletiu principalmente em demissões injustificadas, dificuldades em encontrar emprego ou maus-tratos na prestação de serviços de saúde. Por fim, verificou-se que os participantes expostos a mais discriminação também relataram pior estado geral de saúde. Conclusões: a discriminação é um problema que afeta a comunidade LGBT+, principalmente o coletivo de pessoas trans. As graves implicações da discriminação para a saúde das pessoas evidenciam a necessidade de desenhar estratégias, políticas e regulamentações que visem promover a tolerância e a integração.

RESUMEN Objetivo: analizar la relación entre la discriminación percibida y temida, y la salud general de personas LGBT+ de acuerdo a su nivel educativo, identidad de género y nivel socio-económico. Método: se realizó un estudio transversal y correlacional. La muestra constó de 120 personas participantes mayores de edad de la región del Maule (Chile), pertenecientes a la comunidad LGBT+, que respondieron una encuesta de manera virtual debido a la pandemia por SARS CoV-2. La encuesta también incluyó una pregunta abierta que proporcionó un espacio para que las personas participantes compartieran experiencias de discriminación con respecto al trato recibido del personal de enfermería. Los datos cuantitativos se examinaron mediante análisis descriptivos e inferenciales (pruebas de diferencia de medias y correlaciones). Los relatos extraídos se analizaron siguiendo técnicas de análisis temático y discursivo. Resultados: si bien la discriminación percibida tuvo una prevalencia baja en la muestra, un 44,17% expresó temor a no ser querido, 38,33% a no encontrar trabajo, y 32,51% a ser rechazado por su familia por ser parte de la comunidad LGBT+. Asimismo, la discriminación fue mayor en el grupo de personas trans y se reflejó principalmente en despidos injustificados, dificultades para encontrar empleo o maltratos en la provisión de servicios de salud. Finalmente, se encontró que las personas participantes expuestas a mayor discriminación también reportaron una peor salud general. Conclusiones: la discriminación es un problema que afecta a la comunidad LGBT+, particularmente al colectivo trans. Las serias implicaciones de la discriminación para la salud de las personas ponen de manifiesto la necesidad de diseñar estrategias, políticas y reglamentaciones tendientes a fomentar la tolerancia y la integración.

Riesgos psicosociales e integración profesional de médicos extranjeros: Un estudio sobre el manejo del conflicto en Chile / Psychosocial risks and professional integration of foreign physicians: a study on conflict management in Chile

Background: The way in which communicative conflicts are confronted, as part of the acculturation process, can constitute a psychosocial risk factor that may affect the effectiveness of health care delivery. Aim: To describe the levels of dominance, adaptability and evasion as indicators of the way in which conflict situations are faced in the workplace by foreign physicians in the management of communicative conflicts. Materials and Methods: A self-report questionnaire was answered by 51 foreign physicians (63% women, 76% Venezuelans, 64% aged between 31 and 40 years old) who work in public healthcare institutions in a southern region of Chile. Results: The highest scores were recorded for the adaptable style of conflict management (69%), while the lowest scores were recorded for the evasive style (6%). Higher levels of dominance were identified for women than for men. There was a positive association between dominance and time progression, where the level of dominance increased as participants gained greater professional experience and workplace seniority. Conclusions: The foreign physicians who participated in this study have a clear constructive attitude towards the negotiation of conflicts. However, this effort to adapt can also become a psychosocial risk factor that affects professional integration in intercultural workplace contexts.