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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Taking Concordance Research to a Whole New Level
Significant advance in understanding the meaning of patient-physician discordance
Lessons from social psychology research
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Richard L. Kravitz, Sacramento, CA Professor, UC Davis Department of Internal Medicine
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The results reported in this paper are potentially stunning, because they provide fresh new insights into mechanisms of patient-physician relationship-building and the meaning of "concordance." The data are consistent with the view that concordance is more than skin deep, i.e. much more nuanced than outward similarity. This important study should fuel additional research on what physicians can do to accelerate the accumulation of trust, satisfaction, and positive mutual regard. That said, the data are derived from just just over 200 encounters with 29 physicians, so it is important that the results be confirmed in larger studies. I hope that future research will include what is arguably the most important question of all: Does this physician make you feel cared for? While I agree with Dr. Neill that we are more likely to be persuaded by those we like, there is more than one pathway to liking. Demographic or cultural similarity is one path, but we should be attuned to others. Competing interests: None declared |
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Kevin Fiscella, Rochester Family Physician, Dept of Fam Med, Univ of Rochester
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The findings of this study by Street and colleagues have important implications for patient-physician communication across differences in race, ethnicity, age, gender, and social class. Previous studies have yielded conflicting findings regarding the impact of patient-physician sociodemographic discordance. The study findings suggest that socioemotional factors captured in the construct of perceived personal similarity may explain these discordant findings. The findings suggest that what matters to patients in terms of satisfaction, trust and intent to adhere is whether the patient perceives the physician as similar in terms of values and beliefs. These factors in turn are significantly associated with patient-centered communication suggesting that how physicians communicate with their patients affects patient perceptions. Not surprisingly, factors such as supportive communication and partnership building are associated with patient perception of affinity. Improving these skills represents a potentially important strategy for addressing disparities in health care outcomes. While neither patient race, ethnicity, nor gender was independently associated with perceived similarity, both patient age and educational level were. Further research is needed to determine the extent that these factors reflect differences in health literacy or preferences for communicational style and whether refinements in patient-centered communication can close these remaining gaps. Competing interests: None declared |
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Richard A Neill, USA Physician - academic
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Interesting study that confirms what has been written about extensively in the social psychology realm, most specifically by Robert Cialdini with regard to influence. This paper confirms the principle of liking: we are more likely to adhere to advice from those who we like, and who are like us. As physicians, improved care through improved adherence would be more common when patients like, and are like, their physicians. The other determinants of adherence to recommendations include reciprocity, commitment (or consistency), social proof (or consensus), scarcity, and authority. See: Cialdini: Harnessing the Science of Persuasion. Harvard Business Rewiew Oct 2001, pg 72. Cialdini, Robert B., The Science of Persuasion. Scientific American, Jan 2004 Special Edition, Vol. 14, Issue 1 Competing interests: None declared |
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