Mora Claramita is Professor of Medical and Health Education at Universitas Gadjah Mada, Indonesia, and General Practitioner. His research activity is focused on building more data and observations on the relationship between healthcare providers and patients in Asia, as the cultural context can be very different from that of Western societies.

Mora Claramita August 16, 2021

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Please tell us a bit about yourself.

My name is Mora Claramita. I am a professor and currently head of the medical and health professions training department at Universitas Gadjah Mada (UGM) and general practitioner active at the UGM family doctor clinic.

My studies generally focus on the relationship between doctor and patient, and health care provider and patient. While most of the evidence for patient-centered care comes from Western contexts, Indonesia and Asia are very different in terms of culture. The great distance of power and the collectivist culture are the opposite of the Western individualistic culture (with more equity in the relations between people) in terms of decision-making.

The large hierarchical distance affects the social hierarchical divide in healthcare professional-patient relationships and influences the one-way explanation from doctor to patient. For example, the patient will probably answer “yes” without actually agreeing. Ultimately, the physician may not obtain an accurate history of the patient’s disease, nor explore the patient’s perceptions of the disease. Thus, when the data is incomplete, the diagnosis may be inaccurate, and therefore therapy may be ineffective. In addition, decision making in collectivist cultures will be influenced by family members. Physicians must be aware of the patient’s limited contribution to the consultation, while maintaining patient autonomy in decision-making and “do no harm”. Therefore, a two-way dialogue will be the key to approaching optimal health outcomes in hierarchical and collectivist cultures.

In collaboration with Dr Astrid Pratidina Susilo, our research is funded by the beneficiary STUNED (Government of the Netherlands), the NPT U to U project (Maastricht University with Universitas Gadiah Mada) and the Ministry of Education (Republic of ‘Indonesia).

Some of the highlights of my career include the 2019 Lyn Clearihan Best Paper Award in Asia-Pacific Journal of Family Medicine and the Fulbright Senior Scholar Award 2013-2014, attending the 2014 FAIMER Institute in Philadelphia and being president of the Indonesian College for Health Professions Training.

How did you get into this area of ​​research?

My introduction to patient-centered care started with a role play during my master’s program at Maastricht University, the Netherlands. In one scenario, the simulated patient was out of town and unable to attend the next consultation. As a doctor, I was unaware of this information and continued one-way communication without listening to the patient’s concerns. When she provided constructive feedback, I thought that the one ability I missed during my studies to become a doctor was patient-centered communication skills. I was trained to take the patient’s history and perform general physical exams, but never to deal with the patient’s own concerns.

How does your work relate to SDG3?

Regarding the goals of SDG3, the aim of my research is to ensure that health services are delivered efficiently, in a patient-centered manner, and to consider culture when communicating with patients. patients. For example, the long course of treatment for tuberculosis (TB) will require patient engagement and therefore communication, cultural sensitivity and understanding the patient’s history will be key factors for an optimal healing process.

Indonesia has free medicine and services for TB patients and yet is ranked 2^sd the highest incidence of tuberculosis in the world. Patients cannot simply be diagnosed and receive TB medicine. Patient concerns must be carefully recognized and addressed. By working together hand in hand, health care providers can address these concerns with the help of patients and their families, towards the achievement of tuberculosis treatment. The stigma, the effects of the long course of drugs, the risks of complications and the economic burden must be well communicated and discussed if we are to eradicate TB. The impact of dialogue in communication between patients and health providers plays a role in achieving the SDG3 target – in particular target 3.3: “By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and fight against hepatitis, waterborne diseases and other communicable diseases.

What is the most pressing research question in your field and / or your hopes for progress in the future?

Hierarchical culture – the social divide between doctor and patient – is the main challenge towards effective communication that sustains an alliance between doctor and patient. Active listening is the most basic but most promising communication training in this cultural context. In addition to this, in primary care, patients must be scheduled for appointments to ensure good communication.

The researcher should further explore what and how to communicate with patients in these south-eastern regions of the world towards more partnership communication. More researchers and practitioners should dig deeper into this area which has such an impact on people’s health.

Please describe the obstacles you have encountered in your career.

When I graduated as a doctor of medicine and was working in a university clinic, I did not dream of continuing my professional practice in this clinic, and of course like many other young graduates, I would continue to be a specialist in hospital environment. However, few opportunities to acquire “communication skills” (through role play, practice, feedback) have always stimulated me to learn better. And (it is also a big surprise for me) by doing research I continued my practice until today. Apparently, the topic of “communication skills” has linked my professional practice to my training in the health professions that I study. It is a blessing in disguise. And I also joined a national specialist development program in family medicine, a new specialization in Indonesia, which also requires a lot of communication training.

In terms of barriers – in a society that relies on a hierarchical culture and indirect ways of conversation, it is difficult to explain what I have studied (communication skills) to medical experts. So when I offer communication training to medical residents, the faculty council prefers other humanities experts to do so. However, a trainer without professional healthcare experience may not offer an in-depth perspective on medical diagnosis and treatment and how they relate to communication skills. Often, training in the superficial etiquette of politeness is preferable as a result.

Tell us about a resource or person who 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 every time I publish an article. My studies are also based on the cultural dimension framework of Hofstede, 2010 ‘Culture and organizations’.

Some particular influences and mentors throughout my career have been Professor Cees van der Vleutnen and Dr Jan van Dalen (my thesis supervisors), Dr Gerard Majoor (my masters thesis supervisor) and Professor Mark Alan Graber from the University of Iowa.

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