As individual long-term doctor/patient relationships are increasingly replaced by more transient specialist and group practice contacts, there are likely to be growing doubts about the quality of overall care and communication. One aspect in particular of the quality of medical care involves the communication of information to patients (Donabedian 1980). Previous studies have pointed to a significant level of discontent with the amount and quality of information received by patients from their doctors (Cartright 1979; Boreham & Gibson 1978; Pendleton and Bochner 1980; Reid and McIlwaine 1980; Graham and Oakley 1981)

Najman, J. M.

Shapiro, M. C.

University of Queensland eSpace

Aust Journal of Social Issues, 22(2), 465-471. May 1987 
Socio-economic Status Differences in Patients’ Desire For 
and Capacity to Obtain Information in the Clinical Encounter 
 
M.C. Shapiro and J.M. Najman1
 
As individual long-term doctor/patient relationships are increasingly replaced by more 
transient specialist and group practice contacts, there are likely to be growing doubts 
about the quality of overall care and communication. One aspect in particular of the 
quality of medical care involves the communication of information to patients 
(Donabedian 1980). Previous studies have pointed to a significant level of discontent 
with the amount and quality of information received by patients from their doctors 
(Cartright 1979; Boreham & Gibson 1978; Pendleton and Bochner 1980; Reid and 
Mcllwaine 1980; Graham and Oakley 1981). 
While several previous studies raise questions about the adequacy of the 
communication process, these fail to address a number of important issues. Thus, it is 
possible that little information is provided because most patients prefer to know little, 
leaving technical questions entirely to their doctor. Alternatively, patients might 
desire information but their clinicians may simply be unaware of this desire, or they 
might believe that such information should be withheld for clinical reasons or perhaps 
because the time required to provide the information is unavailable. Further, previous 
research also fails to examine the possibility that some types of patients may be less 
successful in obtaining the information they want (e.g. those of lower social class or 
who receive public care). Finally, it is, of course, possible that the information is 
provided but that it is not clearly understood or recalled by the patient. 
Thus, both the clinician and his or her patient should be studied if one is to understand 
why information provision may contribute to patient discontent. This paper examines 
the extent to which pregnant women, when questioned early in pregnancy, express a 
desire to be better informed about their pregnancies. Obstetricians treating these 
women were also asked about the information they believed their patients wanted 
about the pregnancy. Shortly before the birth pregnant women were questioned again 
and asked to report the information they had obtained and still wanted. The paper 
compares the patients’ initial desire for information with that reported by obstetricians 
and with the extent to which the desired information was obtained. While the findings 
from this study should not be generalized beyond the specific sample and are limited 
by the modest number of women who were studied, the general concern which 
emerges is likely to be applicable to a range of other clinical situations. 
 
Preliminary Observations 
The study began with a three month period of observation in the antenatal clinic of a 
large Australian teaching hospital. Results from the initial investigation formed the 
basis of the questionnaire. Preliminary observations and interviews suggested the 
hypothesis that women wanted a great deal of information in addition to the medical 
treatment they sought. Observations suggested that women regarded antenatal care, in 
part at least, as an opportunity to obtain instructions about diet, exercise, preparation 
for labour and general advice concerning pregnancy. Women appeared to want 
reassurance and to learn more about their pregnancy when visiting their doctor. 
                                                 
1 For further information about the research reported here contact the authors, Departments of 
Anthropology and Sociology and Social and Preventive Medicine, University of Queensland, St. Lucia, 
Queensland 4067. 
Aust Journal of Social Issues, 22(2), 465-471. May 1987 
Interestingly though, when confronted by the doctor, these women failed to express 
their desire for this type of service. It appeared that control of the obstetrical 
encounter was relinquished to the obstetrician who initiated most of the discussions 
which took place. To test and quantify these hypotheses, a survey of pregnant women 
was initiated. 
 
 
The Sample 
The sample consisted of a stratified random sample of 110 women in the first 
trimester of their first pregnancy; these comprised 54 public patients and 56 private 
patients. Selection of the sample involved choosing an arbitrary starting date and 
taking all consecutive women of less than 16 weeks’ gestation having their first baby 
either as a public patient of a large hospital or as a patient of a private obstetrician at 
the same hospital. There were no refusals. Fourteen obstetricians were also asked to 
participate in the study. In most cases these were the same obstetricians attending the 
sample of women. All were male. There were no refusals. 
Women were given a questionnaire at their first obstetrical visit and a subsequent 
questionnaire approximately 20 weeks later. In the first questionnaire women were 
asked to indicate which of a list of topics they would like to obtain information about 
from their doctors. In the second questionnaire they were asked to indicate whether 
each topic had been discussed with the doctor and whether further discussion was still 
desired. A number of demographic items were also recorded. Obstetricians treating 
the women were given a list of some of the major topics and asked whether they 
believed patients wanted to discuss these issues with them. 
 
Results 
Table 1 examines the extent to which women wanted information about a range of 
matters pertinent to the outcome of their pregnancy. Three quarters of the sample or 
more reported they wanted information on all the topics except for alcohol 
consumption (44 per cent wanted information) and smoking (34 per cent). The sample 
appear to particularly want information from their doctors on when to come to 
hospital, labour and breast feeding. When questioned late in pregnancy the women 
reported that, in general, only a minority had discussed the topics with their 
obstetricians. Thus while almost all women, early in pregnancy, indicated they wanted 
to ask their doctor when they should come to hospital, slightly less than half the 
sample report that such discussions took place. 
 
Aust Journal of Social Issues, 22(2), 465-471. May 1987 
Table 1 
Percent of Women Early in Pregnancy Wanting to Discuss Specified Topics with 
their Doctors and Late in Pregnancy Reporting that Such Discussion Took Place 
 
 
 
By contrast obstetricians in the sample believe there is a considerably lesser desire for 
information than that reported by their patients. While the vast majority of women 
wanted information on almost every topic, only three topics are perceived to be of 
interest to 50 percent of more of pregnant women. It would appear that obstetricians 
greatly underestimate the extent to which their patients would like to obtain 
information from them. 
 
Aust Journal of Social Issues, 22(2), 465-471. May 1987 
Table 2 
Percentage of Doctors who Report that Over Half Their Patients Want to 
Discuss These Topics 
 
 
Interestingly women in their first trimester of pregnancy with less education, and 
those who are public patients tend to report a greater desire to discuss the listed topics 
with their obstetricians than do their counterparts. (These results not shown.) 
Although many women state, late in their pregnancies, that they would still like to 
obtain information on the listed topics from their obstetricians, it seems that women 
with less formal education and those who are public patients (Table 3) are generally 
more likely to report they want information from their obstetricians, early as well as 
late in pregnancy. 
 
Table 3 
Education and Type of Patient by Percent of Women in the Third Trimester of 
Pregnancy who State They Want More Information from their Doctors on the 
Following Topics 
 
Aust Journal of Social Issues, 22(2), 465-471. May 1987 
 
 
Discussion 
A large majority of pregnant women in our sample report they want to obtain 
information about a range of factors relevant to their pregnancy. In some ways this 
could be seen as a simple desire to learn more about the problems and procedures they 
may encounter. Knowledge may help to reduce uncertainty and allow more 
confidence and control of the environment. Obstetricians, on the other hand, appear to 
have a different expectation of their patients’ needs. These expectations may be 
oriented to the potentially cataclysmic and life threatening events and consequently 
underestimate the patient’s desire for counselling and information. 
Even though participants in the obstetrical encounter may have the same general goal 
in mind, more specific objectives may influence the interaction greatly. For instance 
Freidson (1970) argues that to a large degree the doctors’ viewpoint involves a 
detached professional orientation. Doctors are believed to perceive a situation in terms 
of a rational 
 
process of elimination involving precise scientific conceptualization. The patient, 
however, views the same situation in a substantially personal way. Patients are 
believed to be more concerned with the possible discomfort, both social and 
economic, that will arise from their condition. For pregnant women giving birth may 
be seen as a major life event, a rite of passage before a substantial change in role and 
lifestyle. 
Of particular interest in this study is the way each socio-economic group perceives the 
situation. Patients with less formal education report a greater desire for information 
from the doctor. This may be a consequence of the poorer knowledge base that less 
Aust Journal of Social Issues, 22(2), 465-471. May 1987 
educated patients possess. The greater degree of information sought by less educated 
women may reflect their lesser use of written literature. Other data, both qualitative 
and quantitative suggested that libraries may be less accessible to lower status persons 
and scientific explanations more difficult to comprehend. Lower status women seem 
to depend upon the medical practitioner for information while middle-upper status 
women more often use written literature to supplement the information they obtain. 
Hence, for less educated women the doctor may be seen as the source of most 
information to do with illness or pregnancy. The possibility that less educated women 
are more dependent upon their doctors is intriguing and should be tested in future 
research. 
The other main finding of the study was that the obstetricians’ perspective more 
accurately appeared to predict the outcome of the encounter and this suggests that he 
(all the obstetricians in this study were males) appears to be in control of the 
interaction process. Many women apparently find it difficult to raise topics which are 
of concern to them. It seems that women are the ‘junior partners’ in the consultation. 
Women seem reluctant to initiate the sort of inquiry that would obtain the information 
they desire. This would appear to be a characteristic of the ‘fee for service’ health 
system where women are public rather than private patients. 
 
Conclusion 
This study has examined the information desired and obtained by pregnant women in 
the course of their obstetrical visits. Reports from the sample of pregnant women 
suggest that relatively few obtain the information they want. Data derived from 
interviews with obstetricians imply that they believe relatively little information is 
sought by their patients. The amount of information that women seem to obtain 
corresponds more closely to the perceptions doctors have of appropriate information 
than to the patients’ stated desires. It seems any change in this situation will need to 
be at the initiative of doctors as the majority of patients do not appear to be assertive. 
While this study is restricted to a sample of pregnant women in Australia there are 
likely to be other clinical situations whichsimilarly leave the patient uninformed. 
Further research should establish the combination of patient and doctor characteristics 
— gender, age, social class background — which may differentially contribute to the 
 
References 
Boreham, P. and Gibson, D. (1978), ‘The informative Process in Private Medical 
Consultations: A Preliminary investigation’, Social Science and Medicine 12, 409-
41.6. 
 
Cartwright, A. (1979), The Dignity of Labour? A Study of Childbearing and 
Induction, Cambridge, Tavistock Publications, University Press. 
 
Donabedian, A. (1980), The Definition of Quality and Approaches to Its Assessment, 
Ann Arbor, Health Administration Press. 
 
Freidson, E. (1970), Professional Dominance: The Social Structure of Medical Care, 
Chicago, Aldine Publishing. 
 
Graham, H. and Oakley, A. (1981), ‘Competing Ideologies of Reproduction: Medical 
arid Maternal Perspectives on Pregnancy,’ in H. Roberts (ed.), Women Health and 
Reproduction, London, Routlege and Kegan Paul, 50-74. 
Aust Journal of Social Issues, 22(2), 465-471. May 1987 
Pendleton, D. and Bochner, S. (1980), ‘The Communication of Medical information 
in General Practice Consultations as a Function of Patients’ Social Class’, Social 
Science and Medicine, 14A, 669-673. 
 
Reid, M. and Mcllwaine, C. (1980), ‘Consumer Opinion of a Hospital Antenatal 
Clinic’, Social Science and Medicine, 1 4A, 363-3 68. 


Socio-Economic Status Differences in Patients' Desire for and Capacity to Obtain Information in the Clinical Encounter

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Socio-Economic Status Differences in Patients' Desire for and Capacity to Obtain Information in the Clinical Encounter

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