Three-party medical consultations in Saudi Arabia: a mixed-methods study
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One of the cultural traditions in Saudi Arabia is that the Saudi female patient has to be accompanied by a third-party on her medical visits, thus giving rise to consultations between three parties. By third-party, I mean a chaperone or a family member who can be a patient’s spouse, parent, adult child, sibling, or relative. This person shares responsibility for the patient’s health and the patient relies on them to support them generally with assistance in terms of their health care needs and especially for medical visits. In this research, I focus on the presence of a third party in medical consultations with reference to patient satisfaction, how patients perceive the role of their chaperones during the medical visit and the nature of three-party medical interactions. To investigate these aspects, a convergent parallel mixed method design was used in order to develop a better understanding of doctor-patient-three party interactions, as no mixed method study has been conducted on these issues in medical consultations in Saudi Arabia. Hence, this study addresses this gap in literature by focusing on the interaction between the Saudi female patients, their male physicians and their chaperones. I have concentrated on the Saudi female patients (from different age groups, i.e. 19-75) for religious and cultural reasons. Therefore, the overall aim of this thesis is to understand the phenomenon of three-party consultations in Saudi Arabia through a variety of aspects including patient satisfaction, patients’ perceptions, and what actually happens in three-party medical interactions (e.g., alignment and epistemic asymmetry). The data for this study included quantitative (i.e. questionnaires) and qualitative (i.e. four open-ended questions and observational and audio-recorded) data collected in one phase from 20 clinics in 3 hospitals in Jeddah in Saudi Arabia (two private and one governmental). A total of 117 female patients along with their chaperones were recruited. Statistical analysis of the questionnaire ratings showed that only patient’s education has a positive effect on patient satisfaction with chaperone involvement. Findings from thematic analysis of the open-ended questions data revealed that patients described three supportive roles of the chaperones, namely emotional, informational and logistical support. The patients’ perceptions regarding their chaperones’ supportive roles are re-evaluated in a real-life context by observing the chaperone’s facilitative role in three-party consultations. Therefore, conversation analysis of the audio-recorded data showed three main patterns of alignment: (1) doctor-patient, (2) chaperone-patient (and patient-chaperone), and (3) chaperone-doctor (and chaperone-patient) alignments. All these actions indicate that the participants were collaboratively involved in the positive interaction and this enhanced patient participation. However, in analysing three exceptional cases from the Chemotherapy and Haematology clinics, it was found that the presence of a chaperone dominates as well as complicates doctor-patient interaction and thus can significantly override or ostracise the patient who does not know her illness. For example, by using the Conversation Analysis approach, various epistemic resources used by the interlocutors (i.e. the oncologist and chaperones) are displayed by which the patient’s epistemic primacy is usurped and her epistemic access is controlled in terms of participation and the amount of information given. In comparing the mixed methods used in this study, congruent and discrepant results are found between the quantitative and qualitative data. In terms of congruent results, overall, the findings of this study concurred on the importance of having a supportive chaperone during a female patient’s medical appointment. Chaperones’ supportive roles appear to differently influence female patients’ symptoms, diagnosis or treatment plan. Chaperones in the current study have provided a useful contribution to the doctor-patient interactions. However, in terms of discrepancy, findings yielded by the conversation analysis (in Chapters 6 and 7) showed a discrepancy between what patients reported (see Chapter 5) about their chaperones’ supportive roles and what their chaperones did in the consultation. For example, the thematic analysis of the open-ended questions found that both genders were equally likely to be active in speaking for the patient. However, the conversation analysis of observational data adds and clarifies to what patients reported about their chaperones speaking on their behalf. The conversation analysis has given a good picture of the chaperone’s supportive role during medical visits in orienting towards patients as being the actual owners of their bodies and illness (see Chapter 6). Therefore, patients were given the chance to present their problem. Chaperones, in working collaboratively with patients and physicians, support the patient and facilitate the physician’s understanding. However, in only two exceptional cases (see Chapter 7) of actual medical interactions, the chaperone acts as a surrogate patient and restricts the patient’s own knowledge of their illness. Therefore, the current study contributes to three important areas, namely: (1) the literature of three-party interactions, (2) three-party interactions in Saudi Arabia, and (3) clinical practices in Saudi Arabia.