[Cognitive structure of family doctors in training concerning the doctor-patient relationship]

To find and compare thought structures of family doctors in training concerning the doctor-patient relationship.

Qualitative and descriptive.

Primary care.

10 first-year residents selected through intentional sampling.

Piaget interview modified by Pinies evaluated with the propositional analysis technique of concepts and conceptual maps. Five thematic areas concerning doctor-patient relationship were defined: importance and repercussions, characteristics and requisites, model of relationship, patient behaviour and doctor's behaviour.

The concepts were not sufficiently elaborated. The importance of the doctor-patient relationship was recognised, but not all its repercussions. Its most oft cited desirable requisite was patient confidence. Those interviewed opted for a relationship in which the patient is passive, although they were aware of the danger of leading questions. The personality of the patient was the most commonly cited determinant of his/her behaviour, but other determinants were mentioned, such as beliefs and expectations. The decision to go for a consultation was not seen just as a product of the symptoms. Denial was the most widely recognised defence mechanism. The role of the doctor's feelings was indicated, but not about how to neutralise them. Training was not emphasised, either.

There was insufficient appreciation of the practical importance of the doctor-patient relationship. A directive model of relationship was most common, lacking any biopsychosocial orientation. Training in this area, even though its need is not perceived, should be prioritised. The kind of knowledge underlying doctors' cognitive structure and its role in their behaviour should be investigated.