Factors associated with the doctor–patient relationship: doctor and patient perspectives in hospital outpatient clinics of Inner Mongolia Autonomous Region, China

Figures & data

Table 1 Demographic characteristics of doctors and univariate analysis of DDPRQ-10 scores

Variable	n	(%)	DDPRQ-10 score
			Mean	SD	P-value*
Level of hospital					0.039
Provincial	116	(51.3)	33.66	6.00
City	110	(48.7)	31.99	6.06
Department					0.024
Surgery	68	(30.1)	32.34^a,b	6.42
Internal Medicine	98	(43.4)	34.04^a	6.30
Others	60	(26.5)	31.47^b	4.89
Sex					0.198
Male	119	(52.7)	32.35	6.27
Female	107	(47.3)	33.39	5.82
Age (years)					0.012
≤30	47	(20.9)	30.83^a	5.70
31–40	124	(55.1)	33.82^b	5.93
41–60	54	(24.0)	32.26^a,b	6.31
Ethnicity					0.067
Han	177	(78.3)	32.43	5.90
Mongolian or others	49	(21.7)	34.35	6.50
Marital status					0.848
Single	30	(13.3)	32.67	5.31
Married	196	(86.7)	32.87	6.19
Academic degree					0.022
Bachelor and below	87	(38.5)	31.54^a	6.48
Master	116	(51.3)	33.90^b	5.62
Doctor	23	(10.2)	32.48^a,b	5.92
Technical title					0.302
Junior	77	(34.1)	32.21	5.85
Middle	90	(39.8)	33.60	6.12
Senior	59	(26.1)	32.53	6.26
Income (RMB/month last year)					0.745
≤4000	80	(35.6)	32.46	6.52
4001–5000	78	(34.7)	33.21	5.24
>5000	67	(29.8)	32.79	6.47
Income satisfaction					0.012
Satisfied	17	(6.2)	29.29^a	5.19
Fair	83	(36.7)	32.33^a,b	5.92
Dissatisfied	126	(55.8)	33.67^b	6.11
Working hours per week					0.081
≤40	17	(7.5)	29.88	6.94
>40	209	(92.5)	33.09	5.95
Number of patients per day					0.320
<30	97	(41.9)	32.36	6.13
≥30	70	(58.1)	33.34	6.47
Pressure					0.003
No pressure	56	(24.8)	30.73	6.02
Pressure	170	(75.2)	33.54^b	5.94
Coordination					0.956
Bad Coordination	40	(17.7)	32.80	5.47
Good Coordination	186	(82.3)	32.85	6.21
Trust feeling from patients					0.048
Low and fair	127	(56.2)	33.54	6.26
High	99	(43.8)	31.95^a	5.72
Environment					<0.001
Good	97	(42.9)	31.20	6.05
Not good	129	(57.1)	34.09	5.81
Negative media influence					0.006
Never	19	(8.4)	30.21^a	5.83
Sometimes	128	(56.6)	32.27^a	6.00
Often	79	(35.0)	34.42^b	5.93
Defensive behavior					<0.001
Never	54	(23.9)	31.28^a	6.55
Sometimes	142	(62.8)	32.49^a	5.70
Often	30	(13.3)	37.37^b	4.08
Medical dispute					0.007
None	92	(40.7)	31.67	5.76
Experienced medical dispute	134	(59.3)	33.73	6.17

Notes: ^a,b,cValues within exposure not having a superscript in common differ significantly (p<0.05, t-test). *P-value from Wald’s test. ^†Includes Gynaecology (8), Obstetrics (7), Paediatrics (2), Ear-nose-throat (15), Traditional Chinese Medicine (10), Laboratory Medicine (5), Rehabilitation (8), Reproductive Medicine department (2), Emergency Department (2), and Medical Services (1).

Figure 1 Percentage of doctors having medical disputes in the previous year by hospital level.

Table 2 Demographic characteristics of patients and univariate analysis of PDR-9 scores

Characteristic	n	(%)	PDR-9 scores
			Mean	SD	P-value*
Level of hospital					0.025
City	337	(47.3)	32.03	7.72
Provincial	376	(52.7)	30.75	7.37
Department					0.614
Internal Medicine	167	(24.0)	31.84	7.46
Surgery	81	(11.6)	31.01	7.23
Others^†	448	(64.4)	31.22	7.69
Sex					0.323
Female	518	(74.9)	31.20	7.55
Male	174	(25.1)	31.85	7.43
Age (years)					0.167
16–30	331	(47.4)	31.75	7.69
31–40	198	(28.3)	30.49	6.94
41–94	170	(24.3)	31.51	7.87
Ethnicity					0.018
Han	595	(83.5)	31.61	7.48^a
Mongolian	90	(12.6)	29.31	7.96^b
Others	28	(3.9)	32.56	7.11^a
Marital status					0.108
Single	122	(17.2)	32.51	7.77
Married	575	(81.1)	31.10	7.51
Others	12	(1.7)	33.50	7.14
Education					0.475
Senior high school and below	249	(35.1)	31.82	7.80
Junior college	231	(32.5)	31.14	7.46
Bachelor and above	230	(32.4)	31.05	7.42
Household Incomes (RMB)					0.216
≤5,000	309	(51.1)	31.92	7.71
5,001–10,000	230	(38.0)	31.20	7.03
>10,000	66	(10.9)	30.26	8.58
Income satisfaction					<0.001
Satisfied	184	(26.8)	33.31^a	7.32
Fair	390	(56.8)	30.71^b	7.34
Dissatisfied	113	(16.4)	30.38^b	8.39
Insurance					0.416
No	133	(18.7)	31.83	7.35
Yes	578	(81.3)	31.25	7.62
Waiting time (minutes)					<0.001
<60	336	(49.9)	32.36^a	7.41
60–179	244	(36.3)	30.88^b	7.46
≥180	93	(13.8)	28.77^c	7.26
Consultation time with doctor (minutes)					<0.001
≤5	269	(41.1)	29.53^a	7.43
6–10	233	(35.6)	32.59^b	6.68
>10	152	(23.2)	32.65^b	7.84
Level of medical knowledge					0.974
Low	141	(19.9)	31.45	8.00
Average	483	(68.1)	31.29	7.32
High	85	(12.0)	31.27	8.18
Expectation of treatment result					<0.001
Low–fair	202	(28.7)	29.13	7.65
High	502	(71.3)	32.19	7.33
Degree of trust in doctor					<0.001
Low–fair	208	(29.5)	27.31	7.04
High	498	(70.5)	33.04	7.05
Hospital environment					<0.001
Not good	236	(33.4)	28.85	7.75
Good	470	(66.6)	32.61	7.07
Frequency of negative media influence					0.013
Never	290	(41.1)	32.00^a	8.03
Sometimes	388	(55.0)	31.04^a	7.01
Often	28	(4.0)	27.89^b	8.50

Notes: ^a,b,cValues within exposure not having a superscript in common differ significantly (P<0.05, t-test). Missing values are not shown in the table. *P-value from Wald’s test. ^†Includes Gynaecology (183), Obstetrics (116), Paediatrics (6), Ear-nose-throat (71), Traditional Chinese Medicine (8), Laboratory Medicine (61), Reproductive Medicine Department (2), and Emergency Department (1).

Table 3 Adjusted coefficients for DDPRQ-10 scores from linear regression

Exposure	Minimally sufficient adjustment set^#	Exposure variable level	Adjusted coefficient	(95% CI)	P-value*
Type of hospital
Total effect	No adjustment	Ref: City	0	–	0.039
		Province	1.66	(0.08, 3.24)
Direct effect	cli, co, ed, env, md, dsp, pnu, psc, tru, wt	Ref: City	0	–	0.116
		Province	−0.62	(−3.01, 1.77)
Clinic
Total effect	No adjustment	Ref: Surgery	0^ab	–	0.024
		Internal Medicine	1.70^a	(−0.16, 3.57)
		Others	−0.87^b	(−2.97, 1.22)
Direct effect	age, co, ed, hos, insa, md, dsp, nati, pnu, psc, prss, sex, tech, tru, wt	Ref: Surgery	0^ab	–	0.012
		Internal Medicine	2.17^a	(−0.40, 4.75)
		Others	−0.82^b	(−3.56, 1.92)
Age (years)
Total effect	No adjustment	Ref: ≤30	0^a	–	0.011
		31–40	2.98^b	(0.96, 5.00)
		>40	1.43^ab	(−0.92 3.78)
Direct effect	cli, ed, insa, md, dsp, pnu, prss, tech, tru, wt	Ref: ≤30	0		0.023
		31–40	2.67	(−0.52, 5.85)
		>40	2.16	(−1.97, 6.30)
Academic degree
Total effect	No adjustment	Ref: Bachelor and below	0^a	–	0.022
		Master	2.36^b	(0.68, 4.03)
		Doctoral	0.94^ab	(−1.83, 3.70)
Direct effect	age, cli, hos, insa, pnu, tech	Ref: Bachelor and below	0	–	0.074
		Master	0.79	(−1.52, 3.10)
		Doctoral	−1.06	(−4.73, 2.61)
Income satisfaction
Total effect	age, cli, ed, pnu, tech	Ref: Satisfied	0^a	–	0.003
		Fair	3.17^ab	(−0.31, 6.64)
		Dissatisfied	4.71^b	(1.28, 8.13)
Direct effect	age, cli, ed, md, pnu, psc, tech, tru	Ref: Satisfied	0^a	–	0.002
		Fair	3.08^ab	(−0.32, 6.48)
		Dissatisfied	3.99^b	(0.57, 7.40)
Working hours per week
Total effect	cli, pnu	Ref: ≤40	0	–	0.042
		>40	3.49	(0.01, 6.97)
Direct effect	age, cli, co, hos, md, dsp, pnu, prs, prss, tru	Ref: ≤40	0	–	0.034
		>40	1.28	(−2.27, 4.83)
Work pressure
Total=Direct	age, cli, md, dsp, tru, wt	Ref: No	0	–	<0.001
		Yes	1.90	(0.04, 3.76)
Environment
Total=Direct	hos	Ref: Good	0	–	0.002
		Average	2.72	(1.04, 4.40)
		Bad	2.59	(0.09, 5.10)
Negative media influence
Total effect	No adjustment	Ref: Never	0^a	–	0.006
		Sometimes	2.06^a	(−0.83, 4.94)
		Often	4.21^b	(1.21, 7.21)
Direct effect	age, cli, co, hos, insa, dsp, pnu, psc, prss, tru, wt	Ref: Never	0	–	0.907
		Sometimes	0.69	(−2.91, 4.29)
		Often	0.86	(−2.98, 4.69)
Trust
Total effect	md	Ref: High	0	–	0.047
		Low	1.11	(−0.51, 2.72)
Direct effect	age, cli, co, hos, insa, md, dsp, pnu, psc, prss, wt	Ref: High			0.026
		Low	0.47	(−1.49, 2.43)
Defensive behavior
Total effect	cli, insa, md, tru	Ref: Never	0^a	–	<0.001
		Sometimes	1.20^a	(−0.61, 3.01)
		Often	5.56^b	(2.91, 8.22)
Direct effect	cli, co, hos, insa, md, dsp, pnu, tru, wt	Ref: Never	0^a	–	<0.001
		Sometimes	1.81^a	(−0.43, 4.06)
		Often	5.24^b	(1.90, 8.57)
Medical dispute
Total effect	co, hos, md, pnu, psc, tru, wt	Ref: Never	0	–	0.054
		Yes	0.28	(−1.80, 2.37)
Direct effect	age, cli, co, hos, md, pnu, psc, prss, tru, wt	Ref: Never	0	–
Yes	1.00	(−1.11, 3.11)	0.035

Notes: ^#In the “Minimally sufficient adjustment set” column, the underlined variables are intermediate variables, others are confounders. ^a,b,cValues within exposure not having a superscript in common differ significantly (t-test). *P-value from Wald’s test.

Abbreviations: co, coordination; ed, education; env, hospital environment; hos, hospital level; insa, income satisfaction; md, media influence; dsp, frequency of medical dispute; nati, nationality; pnu, number of patient per day; psc, defensive behaviour; prss, pressure; tech, technical title; tru, degree of trust; wt, weekly work time.

Table 4 Adjusted coefficients for PDRQ-9 scores from linear regression

Exposure	Minimally sufficient adjustment set	Exposure Variable level	Coefficient	95% CI	P-value*
Hospital type
Total effect	No adjustment	Ref: City	0	–	0.024
		Province	−1.28	(−2.39 −0.17)
Direct effect	Clinic, Environment, Wait time, consultation time	Ref: City	0	–	0.052
		Province	−1.13	(−3.04 0.01)
Direct+waiting time and consultation time effect	Clinic, Environment	Ref: City	0		<0.001
		Province	−2.16	(−3.27 −1.05)
Nationality
Total=Direct	No adjustment	Ref: Han	0^a	–	0.019
		Mongolia	−2.30^b	(−3.97, −0.63)
		Others	0.92^a	(−1.94, 3.78)
Income satisfaction
Total effect	Income	Ref: Satisfied	0^a	–	<0.001
		Fair	−2.79^b	(−4.22, −1.35)
		Dissatisfied	−3.76^b	(−5.65, −1.86)
Direct effect	Age, Income, Insurance	Ref: Satisfied	0^a	–	<0.001
		Fair	−2.70^b	(−4.15, −1.26)
		Dissatisfied	−3.79^b	(−5.70, −1.89)
Waiting time (minutes)
Total=Direct	Clinic, Hospital	Ref: <60	0^a	–	0.002
		60–179	−1.20^a	(−2.47, 0.07)
		≥180	−3.12^b	(−4.89, −1.35)
Consultation time (minutes)
Total=Direct	Clinic, Hospital	Ref: ≤5	0^a	–	<0.001
		6–10	2.89^b	(1.58, 4.19)
		>10	2.98^b	(1.50, 4.46)
Expectation of treatment
Total=Direct	Education, Knowledge	Ref: Low and General	0	–	<0.001
		High	3.10	(1.86, 4.33)
Trust doctor
Total=Direct	Media	Ref: High	0	–	<0.001
		Low and Fair	−5.59	(−6.73, −4.44)
Environment
Total=Direct	Hospital	Ref: Not good	0	–	<0.001
		Good	4.08	(2.92, 5.23)
Negative media influence
Total effect	Education	Ref: Never	0^a	–	0.018
		Sometimes	−0.92^a	(−2.08, 0.23)
		Often	−4.00^b	(−6.94, −1.06)
Direct effect	Education, Trust	Ref: Never	0	–	0.156
		Sometimes	−3.08	(−1.47, 0.71)
		Often	−2.07	(−5.47, 0.07)

Notes: ^#In the “Minimally sufficient adjustment set” column, the variables with underline are intermediate variables, others are confounders. ^a,b,cValues within exposure not having a superscript in common differ significantly (P<0.05, t-test) *P-value from Wald test.

Figure S1 Directed acyclic graph linking difficult doctor–patient relationship as experienced by doctors, sociodemographic and other potentially related variables. In this graph, difficult doctor–patient relationship is shown as the outcome of interest and the work time as the main exposure. For direct effect, age, clinic, coordination, hospital type, media, patient number, prescribe, and trust arepotential confounders. Medical dispute and pressure are intermediate variables.

Figure S2 Directed acyclic graph linking patient–doctor relationship as experienced by patients, sociodemographic and other potentially related variables. In this graph, patient–doctor relationship is shown as the outcome of interest and the hospital type as the main exposure. Department is a potential confounder. Environment, wait time, and consultation time are intermediate variables.