Loyola University Chicago Loyola eCommons Dissertations Theses and Dissertations 1979 Physicians' Perceptions of Self and Patients in a Traditional Culture Adegbola Adejunmobi Loyola University Chicago Follow this and additional works at: https://ecommons.luc.edu/luc_diss Part of the Sociology Commons Recommended Citation Adejunmobi, Adegbola, "Physicians' Perceptions of Self and Patients in a Traditional Culture" (1979). Dissertations. 1784. https://ecommons.luc.edu/luc_diss/1784 This Dissertation is brought to you for free and open access by the Theses and Dissertations at Loyola eCommons. It has been accepted for inclusion in Dissertations by an authorized administrator of Loyola eCommons. For more information, please contact [email protected]. This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. Copyright © 1979 Adegbola Adejunmobi I ·L PHYSICIANS' PERCEPTIONS OF SELF AND PATIENTS IN A TRADITIONAL CULTURE by Adegbola Adejunrnobi A Dissertation Submitted to the Faculty of the Graduate School of Loyola University of Chicago in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy January 1979 ACKNOWLEDGMENTS I wish to express my gratitude to my dissertation director, Dr. Ross P. Scherer, and my readers, Drs. Paul Mundy and Kirsten A. Gr6nbjerg; their critical comments and many suggestions have proven invaluable to me from the inception of the study to its completion. My sincere thanks go to all my teachers in the sociology department, in particular to Fr. Thomas M. Gannon, S.J., chairman of the department, for his help to me during my crucial first semester at Loyola, and Dr. Marcel A. Fredericks, for the exposure afforded me to substantive and methodological aspects of medical sociology during my assistantships. I would like to thank the Nigeria Institute of Social and Economic Research, University of Ibadan, Nigeria, for the scholarship granted me which partly enabled me to study at Loyola, and Dr. Akinsola A. Akiwowo, formerly Ag. Director of the institute, for encouraging me in many ways toward pursuing further graduate studies. A study of this nature is impossible without the cooperation of the subject participants; I am, therefore, expressing my appreciation to the Nigerian doctors who generously allowed themselves to be interviewed and gave their time to complete the questionnaire forms. Being able to go this far in my academic pursuit has immeasurably to do with all members of my family, in particular, my aunt, Mrs. Hannah Abeke (Akanji) Akinpeju, who laid the first foundation of my education, and my parents, Reverend and Mrs. Isaac Adekunle Adejunmobi, who sacrificed a possible life of comfort to give their children a sound education and instilled in them the virtue of delayed gratification; to them I will be forever indebted. ii VITA The author, Adegbola Adejunmobi, is the son of Isaac Adekunle Adejunmobi and Dorcas Kehinde (Akanji) Adejunmobi. He was born March 31, 1934 in Kaduna, Nigeria. His elementary education was obtained in Awe Baptist Day School, Awe, and his secondary education at Baptist Boys' High School, Abeokuta, Nigeria, where he graduated after successfully completing the Senior Cambridge University School Certificate examination in December, 1952. During 1957-58 he was an external student of London University and he passed the Overseas General Certificate of Education examination in English Literature and Latin at advanced levels. He was graduated from Washburn University of Topeka, Topeka, Kansas, in June, 1967 with the degree of Bachelor of Arts in Sociology. In September, 1969, he entered Roosevelt University, Chicago, from which he received the degree of Master of Arts, cum laude, in Sociology in September, 1972. Hewas admitted as full-time graduate student in Sociology, Loyola University of Chicago in September, 1973. Between September, 1975 and January, 1977, he was granted assistantships. The author was a civil servant in the Nigerian government between 1953 and 1963, rising to the grade of Assistant Executive Officer. He was an international teller at a bank, and an office-manager trainee with an insurance company, both in Chicago, between 1967 and 1969. In 1973, he joined the Institute of Social and Economic Research, University of Ibadan, Nigeria; in September of that year, the institute granted him a two-year scholarship to attend Loyola University of Chicago iii TABLE OF CONTENTS Page ACKNOWLEDGMENTS ii VITA . iii LIST OF TABLES vi LIST OF ILLUSTRATIONS . viii Chapter I. INTRODUCTION . 1 The Setting of the Study The People of the City of Lagos Health Care Delivery Services in Lagos and Nigeria in Historical Perspective The Blending of Past and Present Traditional Yoruba Religion and Medical Beliefs and Practices Christianity and the Aladura Sect Islam Ideological Forces Economic Organization Level and Character of Technology Organization of the Health Profession Professional Organization and Dominance: Historical Rise of Physicians in Nigeria Access to and Distribution of Medical Services Overall Quality of Care II . THEORETICAL BACKGROUND AND REVIEW OF THE LITERATURE 32 A Model of Doctor-Patient Relationship The Socio-cultural Matrix Social Roles Social Roles of the Doctor and the Patient in Western Societies Social Roles of the Patient in Non-Western Societies The Work Setting and Doctor's Attitude Empirical Studies Ideal Types iv TABLE OF CONTENTS Chapter Page III. METHODOLOGY . 53 Description of Variables Dependent Variable Independent Variables Hypotheses The Data Data Collection The Respondents Design for Analysis of the Data IV. PHYSICIANS' PERCEPTIONS OF PATIENT ROLES AND CULTURAL ASPECTS OF INDIGENOUS HEALING 68 Technical lnowledge Seeking Me1cal Help Individtials in Cooperation with the Doctor Compliance with Medical Orders Motivation Dependency Other Topics Doctors' Views on Cultural Aspect of Medicine and Traditional Healers Medicine as Culturally Specific The Indigenous Healer and His Practice Indices of Orientations to the Doctor's, Modern Patient's, and Traditional Patient's Roles v. THE INFLUENCE OF PERSONAL ~~ PROFESSIONAL FACTORS IN DOCTORS" PERCEPTIONS OF THE DOCTOR-PATIENT ROLE RELATIONSHIP • . • . • • • . 103 Personal Characteristics of Doctors and Orientation to Doctor-Patient Relationship Professionalism and Doctor-Patient Relationship Organizational Structure and Doctor-Patient Relationship v TABLE OF CONTENTS Page Chapter VI. SUMMARY OF FINDINGS AND DISCUSSION . 143 Discussion Some Implications of Findings and Suggestions Training More General Practitioners Village Projects Cooperation with the Traditional Healers Teaching What the Government Can Do The Media Conclusion Implications of Some of the Findings for Sociology Functionalism and Structuralism Professionalization Professional Socialization Occupation of Father and Community of Rearing as Variables Suggestions for Further Studies BIBLIOGRAPHY 175 APPENDICES vi LIST OF TABLES Table Page 1. General Characteristics of Physician Respondents 64 2. Doctor's Perceptions of Patients' Sick Role Behaviors . • • • • • • • . 71 3. Interrelationships Among the Indices of Orientation 100 4. Orientation to Doctor-Patient Relationship by Age • • • . • 5. Orientation to Doctor-Patient Relationship by Sex . • . 108 6. Orientation to Doctor-Patient Relationship by Occupation of Father • • . • . • 111 7. Orientation to Doctor-Patient Relationship by Place of Rearing • • • • • . • . • • 114 8. Orientation to Doctor-Patient Relationship and Early Education • • . • . • . 117 9. Orientation to Doctor-Patient Relationship by Premedical, Medical and Internship Training 112 10. Orientation to Doctor-Patient Relationship by Field of Practice . • . 126 11. Orientation to Modern Patient Role by Field of Practice . 127 12. Doctor-Patient Relationship by Professional Orientation 130 13. Professional Orientation by Bureaucratic Orientation 134 14. Orientation to Doctor-Patient Relationship by Bureaucratic Orientation . • . • . • • 136 15. Doctor-Patient Relationship and the Work Setting . 137 16. Orientation to Doctor-Patient Relationship by Patients' Educational Background 140 vii LlST OJ; TABLES (continued} Table l?age 17. Distribution of Doctors on Orientations to Doctor and Patient Roles • • • • • • • • • 153 viii LIST OF ILLUSTRATIONS Figure Page 1. The Model of Doctor-Patient Role Relationship • • • t! • • • 33 2. Analytical Frame • 105 3. Map Diagram of Orientations to Overall Doctor- Patient Relationship with Gammas • • • • • • • • • • • . • • 185 4. Map Diagram of Orientations to Doctor's, Modern Patientrs, and Traditional Patient's Roles with Selected Gammas • • • • • • . • . • • • • • • • • • • • • • • 18.6 ix CHAPTER I INTRODUCTION This study attempts to examine the relationship between medical practice and its socio-cultural context; thus the examination involves two levels of analysis: the societal and the institutional. On the macrosociological or societal level, the study will be concerned with the cultural influences that shape the beliefs and practices relative to sickness and health among a selected population of Nigeria; on the microsociological or institutional level, the study will emphasize the importance of the relationship between physicians and patients as an intrinsic feature of health care delivery. A basic assumption of the study of this relationship is that the type of patient that the practicing, modern doctor in a developing society comes in contact with in his practice will be different from the one typically encountered