Interaction Between Doctors and Patients in Russia: Vectors of Change

Abstract

Аlla Chirikova — Chief Research Fellow, Institute of Sociology (RAS). Address: Bldg. 5, 24/35, Krzhizhanovskogo St., Moscow, 117218, Russian Federation. E-mail: chirikova_a@mail.ru.

Sergey Shishkin — Academic Supervisor, Institute for Health Economics, National Research University "Higher School of Economics". Address: 20, Myasnitskaya St., Moscow, 101000, Russian Federation. E-mail: shishkin@hse.ru.

The paper presents the results of an empirical study of Russian doctors and discusses recent changes in their relationships with patients, including choice of treatment and informal payments. Parallel to that, we attempt to establish whether the model of informed consent is being accepted in Russian health care and how doctors evaluate its prospects. The analysis is based on 57 in-depth interviews with medical staff and managers of various health institutions in three Russian regions performed in April and August 2012.
The study reveals that Russian patients have become more exacting towards doctors and there is a growing tension between them. Doctors are aware of this public challenge, and the need to develop relationships with patients based on the principles of partnership, shared decision-making on the choice of treatment, and the division of responsibility for the health of patients. However, it appears that the new model of informed consent faces several difficulties and will not replace paternalism in such relationships in the near future. These findings suggest that there is some information asymmetry between doctors and patients, and in many cases, it leads to quasi-informed decisions and the quasi-rational demand for medical services.
We have also revealed no significant institutional changes in the practices of informal payment for health care. However, there has been a certain change in the attitudes of the medical community towards such practices: doctors and managers of health institutions now openly recognize the normality of receiving such payments from patients when they are initiated on the behalf of the latter. Meanwhile, extorting money from patients is still condemned, but the understanding of this extortion is very selective: it is only recognized with respect to the services of highly skilled professionals and outstanding doctors. All of this, however, indicates the deep embeddedness of such practices in Russian health care.