Welcome to our Meet the SDG3 researcher blog collection. We are interviewing a series of academics and practitioners working in diverse fields to achieve Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages. You can find other posts in this collection here, and discover what else Springer Nature is doing to advance progress towards achieving this goal on our dedicated SDG3 hub.
Please tell us a bit about yourself.
My name is Mora Claramita. I am a Professor and currently the Head of the Department of Medical and Health Professions Education at Universitas Gadjah Mada (UGM), and an active general practitioner at the UGM family doctor clinic.
My studies generally focus on the relationship between doctor and patient, and health provider and patient. While most evidence of patient-centered care comes from western contexts, Indonesia and Asia are quite different in terms of the culture. The wide power distance and collectivist culture are opposite to the western individualistic culture (with more equity in the relationships between people) in terms of decision making.
The wide power distance affects the social hierarchical gap in the health professional-patient relationships and influences the one-way explanation from the doctor to the patient. For instance, the patient will likely respond with ‘yes’ while not being in actual agreement. Ultimately, the doctor may not obtain an accurate history of the patient’s illness, nor explore the patient’s perceptions of the illness. So when the data are incomplete, the diagnosis can be inaccurate, and consequently therapy may be ineffective. Moreover, decision making in collectivist cultures will be influenced by the family members. The doctors should be aware of limited patient’s contribution to the consultation, and still hold on patient’s autonomy in decision making and ‘do no harm’. Therefore, a two-way dialogue will be the key in approaching optimal health outcomes in hierarchical and collectivist cultures.
Working alongside Dr Astrid Pratidina Susilo, our research is funded by the STUNED Grantee (Government of Netherlands), the NPT Project U to U (Maastricht University with Universitas Gadiah Mada) and the Ministry of Education (Republic of Indonesia).
Some of my career highlights include winning the 2019 Lyn Clearihan ‘Best Paper’ Award in Asia Pacific Family Medicine Journal and the 2013-2014 Fulbright Senior Scholar Award, participating in the 2014 FAIMER Institute Philadelphia, and being Chair of Indonesian College of Health Professions Education.
How did you get into this research area?
My introduction to patient-centered care began with a role-play during my Master’s program in Maastricht University, the Netherlands. In one scenario, the simulated patient was out of town and unable to attend the next consultation. As the doctor, I was unaware of this information and continued a one-way communication without listening to the patient’s concerns. When she provided constructive feedback, I thought the one ability that was missed during my study to become a medical doctor was patient-centered communication skills. I was trained to obtain the patient history and conduct general physical examinations, but never to deal with the patient’s own concerns.
How does your work relate to SDG3?
In relation to SDG3 goals, the aim of my research is to ensure that healthcare services are delivered effectively, in a patient-centered way, and consider the culture when communicating with patients. For example, the long course of tuberculosis (TB) treatments will require patient commitment and therefore, communication, cultural sensitivity and an understanding of the patient’s background will be key factors for an optimum healing process.
Indonesia has free services and medication for TB patients and yet, is ranked 2nd highest in the incidence of TB in the world. Patients cannot just be diagnosed and provided with medication for TB. Patients’ concerns should be carefully acknowledged and responded to. By working together hand in hand, health providers can address these concerns with help from the patients and their family, towards accomplishment of TB treatment. The stigma, the effects of the long course of medication, the risks of complication, and the economic burden, should be well communicated and discussed if we want TB to be eradicated. The impact of dialogue in the communication between patients and health providers does play a role in achieving the SDG3 target – specifically target 3.3: ‘By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.’
What’s the most pressing research question in your field and/or your hopes for progress in the future?
The hierarchical culture – the social gap between the doctor and the patient – is the primary challenge towards effective communication that supports an alliance between doctor and patient. Active listening is the most basic yet most promising communication skill training within this cultural context. On top of that, in primary care, patients should be scheduled for appointments to ensure proper communication.
Researcher should explore more what and how to communicate with patients in this south-eastern regions of the world towards more partnership communication. More researchers and practitioners should dig deeper in this area that impacts so much on people’s health.
Please describe hurdles you’ve come across during your career.
When I graduated as a medical doctor and working at a university clinic, I did not dream to continue my professional practice in this clinic, and of course as many other young graduates, I would continue to be a specialist in a hospital. However, few opportunities to learn ‘communication skills’ (through role-play, practice, feedback) always stimulated me to learn better. And (it is also a big surprise for me) while doing research I kept on my practice until today. Apparently the ‘communication skills’ subject has been bridging my professional practice and health professions education that I study. It’s a blessing in disguise. And I also joined a national development on family medicine specialist program, a new specialization in Indonesia, that also requires lots of communication skills training.
In terms of hurdles – in a society that holds on a hierarchical culture and indirect conversational manners, it is difficult to explain what I have been studying (the communication skills) to medical experts. So, when I offer a communication skills training to medical residents, the faculty board prefers other experts in social studies to do it. However, a trainer without a professional background in healthcare may not offer an in-depth perspective on medical diagnosis and treatment and how this relates to communication skills. Often a training on superficial etiquette of politeness is preferred as a result.
Please tell us about a resource or person that has particularly inspired you?
‘Skills for Communicating with Patients’ by Silverman et al., 2016 is the first book I read and it has been my main reference literature whenever I publish an article. My studies are also based on the cultural dimension framework from Hofstede, 2010 ‘Culture and organizations’.
Some special influences and mentors throughout my career have been Prof Cees van der Vleutnen and Dr Jan van Dalen (my PhD supervisors), Dr Gerard Majoor (my Master’s thesis supervisor) and Prof Mark Alan Graber from the University of Iowa.
You can find other posts in this collection here.
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