[Physician/patient relationship in diabetes mellitus type 1 treatment. A qualitative study].

OBJECTIVES

To know the experiences and expectations of diabetes mellitus type 1 (DM1) patients and their relatives as regards the relationships established with doctors, and the impact of such relationships on their strategies to cope with the disease and treatment.

DESIGN

Qualitative design based on focus groups conducted in 2001.

LOCATION

Several health care centres in Granada and Seville, Spain.

PARTICIPANTS

DM1 patients and their relatives and/or carers.

METHOD

Theory-based sampling including the most representative profiles. Qualitative analysis procedure: text coding, triangulation and interpretation of results.

RESULTS

Doctor/patient relationship highly influences the emotional experience of disease and the way patients gain control over it. Interviewed patients said that the relationship with doctors is focused on disease signs and symptoms, leaving emotional aspects aside. Very often, provider communication is built on recrimination and threat. Treatment is imposed rather than agreed, with scarce opportunities for participating in clinical decisions. Patients develop strategies to take their own decisions and adapting treatment to their daily life.

CONCLUSIONS

Patients value a relationship model whereby providers listen and empathise with their situation, understand their difficulties in treatment compliance, encourage them, and adapt recommendations to the personal and emotional circumstances of each patient. They prefer doctors combining professional competence-including relational skills-with humanity and kindness, as well as being capable of assuming their co-responsibility in treatment success.