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Research ArticleOriginal ResearchA

Understanding Concordance in Patient-Physician Relationships: Personal and Ethnic Dimensions of Shared Identity

Richard L. Street, Kimberly J. O’Malley, Lisa A. Cooper and Paul Haidet
The Annals of Family Medicine May 2008, 6 (3) 198-205; DOI: https://doi.org/10.1370/afm.821
Richard L. Street Jr
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Kimberly J. O’Malley
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Lisa A. Cooper
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Paul Haidet
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  • Intent to Adhere
    Amber N Cichon
    Published on: 24 September 2011
  • Taking Concordance Research to a Whole New Level
    Richard L. Kravitz
    Published on: 23 May 2008
  • Significant advance in understanding the meaning of patient-physician discordance
    Kevin Fiscella
    Published on: 16 May 2008
  • Lessons from social psychology research
    Richard A Neill
    Published on: 16 May 2008
  • Published on: (24 September 2011)
    Page navigation anchor for Intent to Adhere
    Intent to Adhere
    • Amber N Cichon, Springfield, MO. USA

    I was wondering what measure or questions you used for intention to adhere to treatment. I am currently working on my thesis and would like to use a measure already validated.

    Competing interests:   None declared

    Competing Interests: None declared.
  • Published on: (23 May 2008)
    Page navigation anchor for Taking Concordance Research to a Whole New Level
    Taking Concordance Research to a Whole New Level
    • Richard L. Kravitz, Sacramento, CA

    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 accum...

    Show More

    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

    Show Less
    Competing Interests: None declared.
  • Published on: (16 May 2008)
    Page navigation anchor for Significant advance in understanding the meaning of patient-physician discordance
    Significant advance in understanding the meaning of patient-physician discordance
    • Kevin Fiscella, Rochester

    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...

    Show More

    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

    Show Less
    Competing Interests: None declared.
  • Published on: (16 May 2008)
    Page navigation anchor for Lessons from social psychology research
    Lessons from social psychology research
    • Richard A Neill, USA

    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 physicia...

    Show More

    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

    Show Less
    Competing Interests: None declared.
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The Annals of Family Medicine: 6 (3)
The Annals of Family Medicine: 6 (3)
Vol. 6, Issue 3
1 May 2008
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Understanding Concordance in Patient-Physician Relationships: Personal and Ethnic Dimensions of Shared Identity
Richard L. Street, Kimberly J. O’Malley, Lisa A. Cooper, Paul Haidet
The Annals of Family Medicine May 2008, 6 (3) 198-205; DOI: 10.1370/afm.821

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Understanding Concordance in Patient-Physician Relationships: Personal and Ethnic Dimensions of Shared Identity
Richard L. Street, Kimberly J. O’Malley, Lisa A. Cooper, Paul Haidet
The Annals of Family Medicine May 2008, 6 (3) 198-205; DOI: 10.1370/afm.821
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More in this TOC Section

  • Investigating Patient Experience, Satisfaction, and Trust in an Integrated Virtual Care (IVC) Model: A Cross-Sectional Survey
  • Patient and Health Care Professional Perspectives on Stigma in Integrated Behavioral Health: Barriers and Recommendations
  • Evaluation of the Oral Health Knowledge Network’s Impact on Pediatric Clinicians and Patient Care
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