[Quality of the physician-patient pedagogic relationship in external consultation: the case of Oaxaca, Mexico ].

This research seeks to explore the quality of the pedagogical relationship physician-patient in primary care, in several health centers (A, B, C) depending from the Health Ministry (SSA) in the state of Oaxaca, Mexico. It is assumed that the out-patient clinic constitutes a setting for the educative transmission, and that the physician-patient encounter must result in an increase of the knowledge that the patient has on his body and his health, with the help of the former. It is assumed also that the physician not only seeks to elaborate a diagnosis and to solve the health problems, but also to contribute to the education of the patient on this matter. This research seeks to contribute to the reflection in this direction, from a perspective that explores the quality and the nature of the educative processes that there take place. In order to reach this goal, two levels of analysis have been established: the first one, a theoretic approach, which refers to the main aspects of the historic evolution of the medicine -key element that permits to understand the type of physician-patient relationship that it is established in out-patient clinic. The second one, an empirical approach, which seeks to characterize -by using indicators previously determined and through the implementation of the technic "shadow study" (direct observation)- the six tasks (identification, clinic history, exploration, diagnosis, medical treatment, and following) that give structure to the physician-patient relationship in out-patient clinic. This elements, indeed, are useful for defining the nature of the pedagogical relationship that is established between these two actors. This investigation was conducted with a sample of 168 patients and 17 physicians, distributed all of them in 9 localities. The results allow us to conclude that, in the majority of the cases, it does not exist a physician-patient relationship, but that it is possible to talk just of a physician-problem relationship. Due to this fact, it is not possible to find the health education of the individuals, as a basic input for the training of the population as co- responsible of his/her health-illness process.