What does patient-centred communication mean in Nepal?


Malcolm Moore, BP Koirala Institute of Health Sciences, Dharan, PO Box 7053, Kathmandu, Nepal.
Tel: 00 977 25 525555; Fax: 00 977 25 520251;
E-mail: malnepal@hotmail.com


Objectives  To ascertain the expectations of Nepalese patients regarding aspects of doctor–patient communication and to review a model of patient-centred care for its appropriateness to Nepalese medical communication training.

Methods  A cross-sectional survey, using an adapted version of the Patient−Practitioner Orientation Scale (PPOS), was undertaken with a random sample of patients attending a general outpatients department in rural Nepal. An alternative survey instrument, derived from the PPOS, was also used.

Results  The following issues were most important to patients: being treated in a friendly and respectful manner; being fully informed, and being given adequate consultation time. Patients were happy for the doctor to be in charge and did not want to seek information outside the doctor’s advice. They expressed a strong preference for receiving advice about preventative care. Patient responses were significantly more ‘doctor-centred’ than those found in comparable studies in the USA.

Discussion  Patients expressed strong preferences for some aspects of patient-centred communication (PCC), but were not very concerned with sharing power and control. Models of PCC in Nepal require modification to reflect these local preferences. The importance of good communication techniques requires emphasis in clinical training and practice. Methods of disseminating information need to be enhanced in this low-literacy setting.