The relationship between health care users’ demand and the health care system’s response: a research on change observed in the health care system, in the hospital and in the territory

Renzo Carli, Rosa Maria Paniccia, Andrea Caputo, Francesca Dolcetti, Enzo Finore, Fiammetta Giovagnoli


Our intent is to present citizens’ demand of health care services in Italy through a research structured in three studies. We used the Emotional Text Analysis (ETA) to lead the three studies: the first study regarded the citizens’ expectations of the healthcare services, the second study regarded the point of view of the hospital personnel (medical doctors and nurses), the third regarded the point of view of the General Practitioners on the health care services. These three studies are briefly presented. Data and outcome of an Assumed Similarity Test applied to all experimental subjects of the three studies in order to make a comparison among them, are also presented. The findings of the Emotional Text Analysis show that citizens, potential users of health services, center their requests on their individual subjectivity, and seek answers both to their suffering and to the feeling of alienation that characterizes the being sick feeling that makes them go to a medical doctor. For their part, general practitioners and hospital doctors immediately transform this subjective feeling in an objective medical diagnosis. Here a first gap emerges between patient’s demand and medical response, leaving the possibility of an alliance on the diagnosis in order to jointly fight the disease. It has long been in place though a change that has expelled the patient also from sharing the diagnostic process, increasingly taken from self-centered dynamics within the healthcare system. This widens the gap between the request of the citizens and the response of the health services, that contributes to that conflictual growth to which defensive medicine gives a dysfunctional answer. The Assumed Similarity Test contributes to the interpretation of the health care dynamic identified in the Emotional Text Analysis; particularly in regard to the unfolding conflict, given by the hypothesis emerging from the data analysis, that a feeling of closeness for the hospital personnel goes along with an emotional stance of overpowering the other.


medical doctor-patient relationship; psychology and hospital; citizens; defensive medicine; collusive dynamic.

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Rivista di Psicologia Clinica. Teoria e metodi dell'intervento

Rivista Telematica a Carattere Scientifico Registrazione presso il Tribunale civile di Roma (n.149/2006 del 17/03/2006)

ISSN 1828-9363