Patients’ Description of Unexpected Interactions: A Critical Ethnography of the Quality of Doctor-Patient Interactions in One Educational Hospital in Shiraz, Iran

Sociologists regularly criticize the unbalanced doctor-patient interaction (DPI). A few previous studies have investigated DPI in developing countries. This study aimed to explore the nature of DPI in one educational hospital in Shiraz, Iran, according to the views of patients and their relatives. This is a critical ethnography study that was conducted using a triangulation strategy in 2014, including156 clinical consultations, 920 hours of participant observations, and 6 focus groups with 51 patients and their families using a critical ethnography method. Sampling was purposeful, and the data were interpreted according to an exploration of the power relationship between the doctor and the patient in the context of the study according to the opinions of patients and their relatives. The study showed that participants faced unexpected interactions, which included four features: unequal, unprofessional, instrumental, and non-cooperative. Although this form of interaction was explored to examine the struggle between the voice of medicine and the voice of the lifeworld, the results showed that the DPI in the context of our study contains hegemonic features, which are related to physicians’ autonomy. These four themes revealed that patients are criticized about this form of interaction. These themes not only are not in line with the responsibilities and ethics of medicine but also are in contrast to it. It seems that patient-centered approaches can help solve the problem. In addition, the health system should monitor DPIs and promote them by reforming their structure.