Physician role and patient behaviour
Ross et al. (1982) found patients in large multi‐speciality organizations were more satisfied with physicians who fit an expected demographic norm (middle‐aged, white men from higher socio‐economic groups). Also, a greater match between role expectations and physician behaviour meant more satisfied respondents (Ditto et al., 1995). There is a clear relationship between medical care satisfaction and patient compliance; when patients are dissatisfied with medical advice they are less likely to cooperate. Ditto et al.(1995) argue that it is healthcare's socio‐emotional component rather than the physician's perceived competence or intelligence that seems to be most important in determining patient satisfaction with their physician, and consequently their adherence to treatment regimens. According to the authors, patients encounter two physician types – authoritarian and egalitarian. The former is defined as one where the physician assumes the role of an expert and primary decision maker. The patient expecting such a role places great faith in the physician's abilities, anticipating the physician will provide clear‐cut treatment. The egalitarian belief, on the other hand, is defined as one where the patient expects the physician to make treatment recommendations, discuss options and allow the patient to participate in treatment decisions (Ditto et al., 1995). Subjects expressing authoritarian beliefs about physician roles tend to show greater healthcare utilization by visiting medical professionals more often. Beliefs about physicians were unrelated to age, gender, marital status, race or education. Authoritarian role expectations were also found to be significantly associated with longer physician‐patient relationships. Authoritarian expectation subjects reported poorer health status than egalitarian ones. Physicians presenting treatment in an egalitarian style were perceived as significantly more competent and inspired greater confidence in both themselves and their prescriptions than did authoritarian physicians. Respondents were less likely to seek a second opinion after an egalitarian prescription. Both authoritarian and egalitarian subjects were more satisfied with the egalitarian physicians than the authoritarian ones (Ditto et al., 1995). This finding, however, seems to contradict earlier studies showing that if there was a greater similarity between the physician's behaviour with the expected role then patient satisfaction would be greater. Authoritarian belief patients also responded as being more satisfied with egalitarian style. Consequently, patient compliance too would be greater for egalitarian than authoritarian physicians even for an authoritarian belief patient. Further research needs to be carried out to address these contradictions.