Prim Care. 1976 Sep;3(3):387-98.
In this discussion we have presented findings from a study of patient acceptance of a nurse-midwife. The significance of the initial encounter for patient acceptance has been interpreted in terms of a primacy effect. The negative effect of the obstetrician's presence during initial encounters between patient and nurse-midwife has been discussed in terms of expectation theory. The theory leads us to predict that the patient's perceptions of competence of the nurse-midwife were more favorable when the obstetrician was absent from the initial encounter than when he was present. Finally we have interpreted the overall ease of communication between the nurse-midwife and patients as a result of mutual participation, and complementary rather than crossed interactions. This ease of communication is a major factor accounting for the general enthusiasm of patients for the nurse-midwife in the provision of office care. The importance of interpersonal relationships between health professionals and patients for effective patient care cannot be overstated. Romano has stressed the importance of the doctor-patient relationship in obstetrics and gynecology because of the many anxieties and concerns of women concerning their health problems. Hopefully, our findings will encourage physicians to explore the role of mid-level health professionals and particularly nurse-midwives in enhancing the overall quality of health care for women.
在本次讨论中，我们展示了一项关于患者对助产士接受度的研究结果。初次接触对患者接受度的重要性已根据首因效应进行了解释。产科医生在患者与助产士初次接触时在场所产生的负面影响已根据期望理论进行了讨论。该理论使我们预测，在初次接触时产科医生不在场时，患者对助产士能力的认知比其在场时更有利。最后，我们将助产士与患者之间总体上轻松的沟通解释为相互参与以及互补而非交叉互动的结果。这种轻松的沟通是患者普遍热衷于助产士提供门诊护理的一个主要因素。卫生专业人员与患者之间的人际关系对有效的患者护理的重要性再怎么强调也不为过。罗曼诺强调了医患关系在妇产科中的重要性，因为女性对自身健康问题存在诸多焦虑和担忧。希望我们的研究结果将鼓励医生探索中级卫生专业人员，特别是助产士在提高女性整体医疗保健质量方面的作用。
