BMJ  2003;327:450 (23 August), doi:10.1136/bmj.327.7412.450-a

Letter

Doctor-patient communication in developing countries

The first 150 words of the full text of this article appear below.

EDITOR—As in the United Kingdom, patients in Guinea consider communication with health professionals important.^{1 2} Unfortunately, in developing countries, biomedicine is the dominant paradigm,³ and poor communication is the rule in public services.⁴ Why does communication weigh so little in health policies in developing countries?

The biomedical model was widely disseminated during the colonial period. Fifty years later, interventions to control disease are still the key delivery pattern for public services. Quantitative objectives predominate and clinical decision making is hyperstandardised at the expense of individually tailored care.

The problem is not limited to public facilities. Although the private sector may have a reputation for offering a better doctor-patient relationship and more confidential care, there are plenty of reasons to doubt the presence of a patient centred approach even here:

• Patient centred care is barely reflected in the medical curriculum in developing countries³
  
• Private practitioners may have little interest in . . . [Full text of this article]

Department of Public Health, Institute of Tropical Medicine, 155 Nationalestraat, D-2000 Antwerp, Belgium

pghilbert@itg.be Department of Public Health, Institute of Tropical Medicine, 155 Nationalestraat, D-2000 Antwerp, Belgium

Liverpool School of Tropical Medicine, Liverpool L3 5QA

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