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How Can Respectfulness in Medical Professionals Be Increased? A Complex But Important Question

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Abstract

Respectfulness is demanded of doctors and predicts more positive patient health-related outcomes, but research is scarce on ways to promote it. This study explores two ways to conceptualize unconditional respect from medical students, defined as respect paid to people on the basis of their humanity, in order to inform strategies to increase it. Unconditional respect conceptualized as an attitude suggests that unconditional respect and conditional respect are additive, whereas unconditional respect conceptualized as a personality trait suggests that people who are high on unconditional respect afford equal respect to all humans regardless of their merits. One hundred and eighty-one medical students completed an unconditional respect measure then read a description of a respect-worthy or a non-respect-worthy man and indicated their respect towards him. The study found a main effect for unconditional respect and a main effect for target respect-worthiness but no interaction between the two when respect paid to the target was assessed, supporting the attitude-based conceptualization. This suggests that unconditional respect can be increased through relevant interventions aimed at increasing the relative salience to doctors of the human worth of individuals. Interventions to increase unconditional respect are discussed.

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Notes

  1. The status of the target was also manipulated by introducing him as a patient or a professional in a non-medical context. This manipulation was carried out because of indications in the literature that medical students and doctors sometimes depersonalize patients (Dyrbye et al. 2008; Haque and Waytz 2012; Wahlqvist et al. 2005), in which case they would not apply their attitude of unconditional respect to them. However, this factor did not have an effect on Paid Respect and did not interact with UR or respect-worthiness so in the interests of clarity, it is not mentioned further in the paper and the word “target” has been used.

  2. The fit of each factor model of interest was evaluated using the Tucker-Lewis index (TLI), the comparative fit index (CFI), the root-mean-square error of approximation (RMSEA) with a 90 per cent confidence interval (CI), and the standardized root-mean square residual (SRMR). TLI and CFI values ≥ 0.90 and RMSEA and SRMR values < 0.08 indicate acceptable model fit whilst TLI and CFI values ≥ 0.95 and RMSEA values < 0.06 and SRMR values ≤ 0.05 indicate good model fit (Hu and Bentler 1999; MacCallum, Browne, and Sugawara 1996). Small sample robust estimates using the swain function (Herzog, Boomsma, and Reinecke 2007) are presented for the CFI, TLI, and RMSEA fit indices, given that larger samples are often advised for CFA. We also evaluated the fit of a one-factor model (postulating that all items are influenced by a single factor) and a two-factor model (postulating two correlated factors—a behavioural and a cognitive/affective factor—explaining variation in the items) but these were a poor fit to the data. The fit of a second-order model, postulating three factors whose correlations are explained by a higher order factor (unlike the bifactor model for which the general factor and grouping factors are on an equal conceptual footing in explaining item covariance), was also evaluated. The second-order model showed a just acceptable fit on all indices except the TLI, whose value of 0.89 was below the 0.90 threshold for acceptable model fit.

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Authors and Affiliations

  1. Centre for Hearing and Balance Studies, University of Bristol, Bristol, UK

    Claudine Clucas & Lindsay St Claire

  2. Psychology Department, University of Chester, Parkgate Road, Chester, UK

    Claudine Clucas

  3. Experimental Psychology Department, University of Bristol, The Priory Road Complex, Priory Road, Bristol, UK

    Lindsay St Claire

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  1. Claudine Clucas
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  2. Lindsay St Claire
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Correspondence to Claudine Clucas.

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Clucas, C., Claire, L.S. How Can Respectfulness in Medical Professionals Be Increased? A Complex But Important Question. Bioethical Inquiry 14, 123–133 (2017). https://doi.org/10.1007/s11673-016-9758-5

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