The relationship between the lack of training in communication skills and the use of defensive medicine in Mexico and Per

Keywords: communication skills, effective communication, defensive medicine, doctor-patient relationship

Abstract

The communication between doctor and patient is highly relevant as it can influence patients’ health outcomes, their adoption of treatment, their decision to continue or discontinue it, and their satisfaction with the care provided by physicians. On the other hand, defensive medicine encompasses medical attention that does not increase patient benefits and results in the overuse of medical services, driven by the physician’s fear of being sanctioned and/or preventing litigation risks. This research aimed to explore the relationship between the lack of training in communication skills among physicians and defensive medicine. The design was non-experimental, correlational; using a logical deductive method and a quantitative approach. The population studied consisted of physicians from Mexico and Peru, with a sample of 350 professionals (175 from each country). It reaffirmed the importance of training in communication skills for physicians; however, it was evident that a high percentage did not receive such training or received it in a very basic manner. Their behaviors indicated the practice of defensive medicine (although not all were familiar with the concept) and suggested that better communication training could influence a change in attitude.

Downloads

Download data is not yet available.

References

Al-Balas, Q. A. E., & Al-Balas, H. A. E. (2021). The ethics of practicing defensive medicine in Jordan: a diagnostic study. BMC Medical Ethics, 22(87), 1-7. https://doi.org/10.1186/s12910-021-00658-8

Andorno, R. (2019). La dignidad humana como principio biojurídico y como estándar moral de la relación médico-paciente. Arbor, 195(792), 1-10. https://doi.org/10.3989/arbor.2019.792n2002

Arnold, R. M., Back, A. L., Baile, W. F., Edwards, K. A., & Tulsky, J. A. (2017). The Oncotalk/Vitaltalk model. En D. W. Kissane, B. D. Bultz, Phyllis N. Butow, C. L. Bylund, S. Noble & S. Wilkinson (Eds.), Oxford Textbook of Communication in Oncology and Palliative Care (2.a ed., pp. 363-368). Oxford University Press. https://doi.org/10.1093/med/9780198736134.003.0056

Back, A. L. (2015). The Myth of the Demanding Patient. JAMA Oncol., 1(1), 18-19. https://doi.org/10.1001/jamaoncol.2014.185

Bai, S., Wu, B., Yao, Z., Zhu, X., Jiang, Y., Chang, Q., Bai, Q., & Tong, T. (2019). Effectiveness of a modified doctor-patient communication training Programme designed for surgical residents in China: a prospective, large-volume study at a single Centre. BMC Medical Education, 19(338), 1-10. https://doi.org/10.1186/s12909-019-1776-7

Baungaard, N., Skovvang, P. L., Assing Hvidt, E., Gerbild, H., Andersen, M. K., & Lykkegaard, J. (2022). How defensive medicine is defined in European medical literature: a systematic review. BMJ Open, 12(1), 1-13. https://doi.org/10.1136/bmjopen-2021-057169

Bengoechea, C., Molinero, C., Velasco, C., & López-Ibor, B. (2021). Análisis del uso y funciones del silencio en la comunicación de los profesionales sanitarios en una unidad de oncología pediátrica. Psicooncología, 18(1), 173-191. https://doi.org/10.5209/psic.74538

Berlin L. (2017). Medical errors, malpractice, and defensive medicine: an ill-fated triad. Diagnosis, 4(3), 133-139. https://doi.org/10.1515/dx-2017-0007

Bermúdez-Román, V., Bran-Piedrahita, L., Palacios-Moya, L., & Posada-Zapata, I. C. (2016). Relación médico-paciente: impacto en las campañas de promoción y prevención para personas con VIH, Medellín 2012. Revista de Salud Pública, 18(4), 543-553. http://dx.doi.org/10.15446/rsap.v18n4.41665

Bing-You, R., Hayes, V., Varaklis, K., Trowbridge, R., Kemp, H., & McKelvy, D. (2017). Feedback for Learners in Medical Education: What Is Known? A Scoping Review. Academic Medicine, 92(9), 1346-1354. https://doi.org/10.1097/acm.0000000000001578

Brindley, P. (2019). Commentary: Communication: The Most Important “Procedure” in Healthcare and Bioethics. Cambridge Quarterly of Healthcare Ethics, 28(3), 415-421. https://doi.org/10.1017/s0963180119000331

Brownlee, S., Chalkidou, K., Doust, J., Elshaug, A. G., Glasziou, P., Heath, I., Nagpal, S., Saini, V., Srivastava, D., Chalmers, K., & Korenstein, D. (2017). Evidence for overuse of medical services around the world. Lancet (London, England), 390(10090), 156–168. https://doi.org/10.1016/S0140-6736(16)32585-5

Calikoglu, E. O., & Aras, A. (2020). Defensive medicine among different surgical disciplines: A descriptive cross-sectional study. Journal of Forensic and Legal Medicine, 73, 1-6. https://doi.org/10.1016/j.jflm.2020.101970

Chaudhary, A., & Barwal, V. K. (2022). Defensive medicine in the context of the Indian health system. Indian Pediatrics, 59, 882-884. https://doi.org/10.1007/s13312-022-2649-4

Chirivella González, V., Ribal Sanchis, J., Martí Selva, M. L., Grau Gadea, G., Conejero López, M., & Maroto Álvarez, C. (2019). Evaluación de la Competencia Transversal 8: Comunicación efectiva. En C. Calafat (Ed.), I Jornada de innovación en docencia universitaria para la dirección de organizaciones públicas y privadas (pp. 50-59). Editorial Universitat Politècnica de València. https://doi.org/10.4995/JIDDO2019.2019.10237

Clínica Universidad de Navarra (2000). Diccionario médico. https://www.cun.es/diccionario-medico/terminos/medicina-defensiva

Colegio Médico de México A. C. (2021). Estatutos del Colegio Médico de México. FENACOME. https://www.colegiomedicodemexico.com/assets/files/ESTATUTOSFENACOME-VER12MAY2021.pdf

Colegio Médico del Perú (2023). Código de Ética y Deontología 2023. https://www.cmp.org.pe/wp-content/uploads/2023/02/Actualizacion-Codigo-de-etica-ultimarevision-por-el-comite-de-doctrina01feb.pdf

Congreso de la Unión, Cámara de Diputados (2024). Ley General de Salud. https://www.diputados.gob.mx/LeyesBiblio/pdf_mov/Ley_General_de_Salud.pdf

Cruz-Valiño, A. B. (2019). Medicina defensiva: significado vs medición. Anales del Sistema Sanitario de Navarra, 42(1), 109-111. https://doi.org/10.23938/assn.0383

Escalona Velázquez, L. F., & Sánchez Cruz, Y. V. (2018). Comunicación asertiva en cirugía pediátrica. Revista Caribeña de Ciencias Sociales, 10. https://www.eumed.net/rev/caribe/2018/10/comunicacion-cirugia-pediatrica.html

Estévez Abad, F., & Estévez Vélez, A. (2021). Comunicación efectiva en salud: evaluación de una experiencia docente en estudiantes de medicina de Cuenca, Ecuador. Revista de Bioética y Derecho, (52), 85-104. https://dx.doi.org/10.1344/rbd2021.52.34162

Fineschi, V., Arcangeli, M., Di Fazio, N., Del Fante, Z., Fineschi, B., Santoro, P., Frati, P., & Associazione Consulcesi Health and ONLUS Futura Ricerca. (2021). Defensive Medicine in the Management of Cesarean Delivery: A Survey among Italian Physicians. Healthcare, 9(9), 1-10. https://doi.org/10.3390/healthcare9091097

Foldesi, E., Zörgő, S., Nyirő, J., Péter, G., Ottóffy, G., Hauser, P., & Hegedűs, K. (2022). Medical Communication during the Transition to Palliative Care in Pediatric Oncology in Hungary - The Parents’ Perspective. Children, 9(5), 1-12. https://doi.org/10.3390/children9050651

Franco Britos, M. A., Denis, A., Morel Ayala, Z., Solalinde, M. C., Ferreira Gaona, M., & Díaz Reissner, C. (2018). Medicina defensiva en Servicios de Urgencias del Hospital Central del Instituto de Previsión Social. Revista Virtual de la Sociedad Paraguaya de Medicina Interna, 5(1), 25-35. https://doi.org/10.18004/rvspmi/2312-3893/2018.05(01)25-035

Gamboa, C., & Valdés, S. (2015). Responsabilidad de los Profesionales de la Salud. Derecho comparado a nivel internacional y local, Iniciativas presentadas y Notas Periodísticas (Segunda Parte). Cámara de Diputados. https://www.diputados.gob.mx/sedia/sia/spi/SAPI-ISS-80-15.pdf

Hamui Sutton, L., Paulo Maya, A., & Hernández Torres, I. (2018). La comunicación dialógica como competencia médica esencial. Manual Moderno, Facultad de Medicina, UNAM.

Instituto Tecnológico y de Estudios Superiores de Monterrey (2024a). Plan de estudios 2024, Médico cirujano. Curso Ética, Persona y Sociedad. https://samp.itesm.mx/Materias/VistaPreliminarMateria?clave=H1018&lang=ES

Instituto Tecnológico y de Estudios Superiores de Monterrey (2024b). Plan de estudios 2024, Médico cirujano. Curso Bellas Artes. https://samp.itesm.mx/Materias/VistaPreliminarMateria?clave=CO1005&lang=ES

Lee, T., Lin, E. C., & Lin, H. C. (2022). Communication skills utilized by physicians in the pediatric outpatient setting. BMC Health Services Research, 22(993), 1-7. https://doi.org/10.1186/s12913-022-08385-5

Lenkiewicz, J., Lenkiewicz, O., Trzciński, M., Sobczak, K., Plenikowski, J., Przeniosło, J., & Kotłowska, A. (2022). Delivering Bad News: Self-Assessment and Educational Preferences of Medical Students. International Journal of Environmental Research and Public Health, 19(5), 1-9. https://doi.org/10.3390/ijerph19052622

Lockwood, B. J., Gustin, J., Verbeck, N., Rossfeld, K., Norton, K., Barrett, T., Potts, R., Towner-Larsen, R., Waterman, B., Radwany, S., Hritz, C., Wells-Di Gregorio, S., & Holliday, S. (2022). Training to Promote Empathic Communication in Graduate Medical Education: A Shared Learning Intervention in Internal Medicine and General Surgery. Palliative Medicine Reports, 3(1), 26-35. https://doi.org/10.1089/pmr.2021.0036

LP, Pasión por el Derecho. (2024). Código Penal peruano [actualizado 2024]. https://lpderecho.pe/codigo-penal-peruano-actualizado/

Macías, V., Garcia, Z., Pavlis, W., Fowler, Z., Uribe-Leitz, T., Gilbert, H., Roa, L., & DelVecchio Good, M.-J. (2022). Interpersonal challenges in surgical care provision in rural Mexico: A qualitative study. The Lancet Regional Health - Americas, 10, 1-11. https://doi.org/10.1016/j.lana.2022.100210

Ministerio de Salud. (15 de julio de 1997). Ley N.o 26842. Ley General de Salud. Gobierno del Perú. https://www.gob.pe/institucion/minsa/normas-legales/256661-26842

Passos dos Santos, R., Garros, D., & Carnevale, F. (2018). Difficult decisions in pediatric practice and moral distress in the intensive care unit. Revista Brasileira de Terapia Intensiva, 30(2), 226-232. https://doi.org/10.5935%2F0103-507X.20180039

Pedreros, C. (2019). Competencias y habilidades del médico en cuidados críticos en Chile. Revista Médica Clínica Las Condes, 30(2), 110-119. https://doi.org/10.1016/j.rmclc.2018.12.006

Perin, A. (2018). La redefinición de la culpa (imprudencia) penal médica ante el fenómeno de la medicina defensiva. Bases desde una perspectiva comparada. Política criminal, 13(26), 858-903. https://dx.doi.org/10.4067/S0718-33992018000200858

Petrone, P. (2021). Principios de la comunicación efectiva en una organización de salud. Revista Colombiana de Cirugía, 36(2), 188-192. https://doi.org/10.30944/20117582.878

Pun, J. (2021). A study of Chinese medical students’ communication pattern in delivering bad news: an ethnographic discourse analysis approach. BMC Medical Education, 21(286), 1-10. https://doi.org/10.1186/s12909-021-02724-6

Quacquarelli Symonds. (2023). QS World University Rankings 2023: Top global universities. https://www.topuniversities.com/world-university-rankings/2023

Quispe, R. C., Muñoz, E. M., Cadillo, A. V., & Ticse, R. (2019). Percepción de la competencia

comunicativa médica durante la entrevista clínica en un hospital docente peruano: validación y aplicación de un instrumento evaluativo. Medwave, 19(9), 1-9. https://doi.org/10.5867/medwave.2019.09.7705

Ries, N. M., & Jansen, J. (2021). Physicians’ views and experiences of defensive medicine: An international review of empirical research. Health Policy, 125(5), 634-642. https://doi.org/10.1016/j.healthpol.2021.02.005

Ries, N. M., Johnston, B., & Jansen, J. (2022). A qualitative interview study of Australian physicians on defensive practice and low value care: “it’s easier to talk about our fear of lawyers than to talk about our fear of looking bad in front of each other”. BMC Medical Ethics, 23(16), 1-14. https://doi.org/10.1186/s12910-022-00755-2

Ríos Ruiz, A. A., & Fuente del Campo, A. (2017). El derecho humano a la salud frente a la responsabilidad médico-legal: una visión comparada. Comisión Nacional de los Derechos Humanos. https://www.corteidh.or.cr/tablas/r37807.pdf

Rudey, E. L., Leal, M. C., & Rego, G. (2021). Defensive medicine and cesarean sections in Brazil. Medicine, 100(1). https://doi.org/10.1097/MD.0000000000024176

Shamoradifar, Z., Asghari-Jafarabadi, M., Nourizadeh, R., Mehrabi, E., Namdar Areshtanab, H., & Shaigan, H. (2022). The impact of effective communication-based care on the childbirth experience and satisfaction among primiparous women: an experimental study. Journal of the Egyptian Public Health Association, 97(12), 1-9. https://doi.org/10.1186/S42506-022-00108-2

Silverman, J., Kurtz, S., & Draper, J. (2013). Skills for Communicating with Patients (3.a ed.). CRC Press. https://doi.org/10.1201/9781910227268

Stiefel, F., Kiss, A., Salmon, P., Peters, S., Razavi, D., Cervantes, A., Margulies, A., & Bourquin, C. (2018). Training in communication of oncology clinicians: a position paper based on the third consensus meeting among European experts in 2018. Annals of Oncology, 29(10), 2033-2036. https://doi.org/10.1093/annonc/mdy343

Tavakoly Sany, S. B., Behzhad, F., Ferns, G., & Peyman, N. (2020). Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: a randomized controlled trial. BMC Health Services Research, 20(60), 1-10. https://doi.org/10.1186/s12913-020-4901-8

Tran, T. Q., Scherpbier, A. J. J. A., Van Dalen, J., Van, D. D., & Wright, E. P. (2020). Nationwide survey of patients’ and doctors’ perceptions of what is needed in doctor – patient communication in a Southeast Asian context. BMC Health Services Research, 20(946), 1-11. https://doi.org/10.1186/s12913-020-05803-4

Ünal, Ö., & Akbolat, M. (2022). Defensive Medicine Practices: Scale Development and Validation. Medical Decision Making, 42(2), 255-261. https://doi.org/10.1177/0272989X211043077

Universidad Nacional Autónoma de México. (2018). Facultad de Medicina. Medicina Psicológica y Comunicación. http://www.facmed.unam.mx/fm/pa/2018/020305_MPC.pdf

Universidad Nacional Mayor de San Marcos. (2018). Cursos generales. Lenguaje. https://viceacademico.unmsm.edu.pe/wp-content/uploads/2018/11/salud-todos-lossi%CC%81labos-2018-II.pdf

Universidad Peruana Cayetano Heredia. (2023). Plan de Estudios 2023. Carrera profesional de Medicina. https://medicina.cayetano.edu.pe/wp-content/uploads/sites/2/2023/03/Plan_de_Estudios_MEDICINA_2023.pdf

Vento, S., Cainelli, F., & Vallone, A. (2018). Defensive medicine: It is time to finally slow down an epidemic. World Journal of Clinical Cases, 6(11), 406-409. https://doi.org/10.12998/wjcc.v6.i11.406

Published
2024-05-31
How to Cite
Cruz Donayre, C. V., Morales Cruz, G. A., & Antezana Corrieri, M. E. (2024). The relationship between the lack of training in communication skills and the use of defensive medicine in Mexico and Per. Contratexto, (41), 46-67. https://doi.org/10.26439/contratexto2024.n41.6834