Article Figures & Data
Figures
- Figure 1.
Racial concordance and patients’ perceptions of perceived personal similarity to the physician.
a,b Means with different superscripts were signiflcantly different at P<.04.
- Figure 2.
Racial concordance and patients’ perceptions of perceived ethnic similarity to the physician.
a,b Means with different superscripts were signiflcantly different at P<.001.
Tables
ES = ethnic similarity; PS = personal similarity. Note: Response options: very similar, moderately similar, slightly similar, slightly different, moderately different, very different. Responses on items 1 through 4 were summed to create a measure of perceived personal similarity. Responses on items 6 through 10 were summed to create a measure of perceived ethnic similarity. The way my doctor and I speak is .................. (PS)
The way my doctor and I reason about problems is ................... (PS)
My doctor and I have.................. styles of communication(PS)
My doctor and I have.................. general values in life(PS)
My doctor and I have.................. spiritual beliefs(PS)
My doctor and I have.................. ethnic backgrounds(ES)
The types of people I spend my free time with and the types of people my doctor spends his/her free time with are ................... (ES)
My doctor and I are.................. in terms of race(ES)
My doctor and I are.................. in terms of culture(ES)
My doctor and I are.................. in terms of skin color(ES)
Characteristic Patients (n=214) Physicians (n=29) Mean age, years (SD) 55.5 (14.7) 40.0 (8.1) Female, % 59 38 Ethnicity Black, % 50 28 White, % 38 31 Hispanic, % 12 0 Asian, % 0 41 Education Less than high school, % 14 0 High school, % 28 0 Some college, % 36 0 College degree, postgraduate, % 22 100 - Table 3.
Factors Affecting Patients’ Perceptions of Similarity to the Physician (N = 214 Patients)
Perceived Personal Similarity Perceived Ethnic Similarity Factor Estimate (SE) P Estimate (SE) P HS = high school; ref = reference population. Doctor race=black (ref=white) 1.01 (3.16) .94 2.63 (5.86) .65 Doctor race=Asian (ref=white) 0.25 (3.17) .75 −4.89 (5.83) .40 Doctor age 0.04 (0.15) .79 0.10 (0.28) .72 Race discordant=black/Hispanic patient (ref=race concordant) −3.48 (2.44) .16 −31.56 (4.23) .000 Race discordant=white patient (ref=race concordant) −3.27 (2.87) .26 −34.06 (4.99) .000 Sexual concordance 1.46 (2.00) .47 2.21 (3.56) .54 Patient age 0.20 (0.07) .005 0.26 (0.12) .032 Patient sex (ref = female) −0.89 (2.13) .68 −4.39 (3.74) .24 Patient education (<HS, HS, some college, college graduate) 1.98 (0.95) .039 2.84 (1.65) .085 Number of previous visits −0.39 (0.83) .64 1.73 (1.45) .24 Physicians’ patient-centered communication 0.34 (0.13) .008 −0.06 (0.22) .78 - Table 4.
Concordance and Perceived Similarity Effects on Outcome Measures (N = 214 Patients)
Patient Involvement Patient Trust Patient Satisfaction Likely to Adhere Feature Estimate (SE) P Estimate (SE) P Estimate (SE) P Estimate (SE) P HS = high school; ref = referent. a The significance of this effect may in part be a statistical artifact, since the bivariate relationship between patient age and intent to adhere was not significant. Doctor race = black (ref = white) −0.69 (1.08) .52 2.30 (2.15) .29 3.15 (1.59) .049 1.26 (3.11) .72 Doctor race=Asian (ref=white) 0.10 (1.10) .93 −5.28 (2.25) .02 −0.01 (1.70) .99 1.18 (3.25) .69 Doctor age 0.06 (0.05) .22 −0.03 (0.10) .79 0.11 (0.07) .12 0.27 (0.15) .062 Race discordant=black/Hispanic patient (ref=race concordant) 0.24 (1.01) .81 −2.10 (2.37) .38 −1.54(1.96) .43 4.74 (3.42) .17 Race discordant=white patient (ref=race concordant) 1.82 (1.16) .12 −2.93 (2.69) .12 0.59 (2.20) .79 2.45 (3.89) .53 Sexual concordance 0.34 (0.72) .64 −0.18 (1.54) .91 1.99 (1.19) .09 −1.91 (2.23) .39 Patient age 0.04 (0.03) .16 −0.08 (0.06) .20 0.06 (0.05) .21 −0.21 (0.09) .02a Patient sex (ref = female) −1.25 (0.77) .10 −3.26 (1.67) .06 −1.04 (1.35) .44 −3.05 (2.46) .22 Patient education (<HS, HS, some college, college graduate) 0.69 (0.35) .052 −0.77 (0.82) .35 −0.51 (0.68) .45 0.02 (1.19) .99 Number of previous visits −0.56 (0.30) .061 1.49 (0.66) .026 0.18 (0.52) .72 1.15 (0.95) .23 Physicians’ patient-centered communication 0.35 (0.05) .000 0.22 (0.10) .028 0.20 (0.08) .01 0.39 (0.14) .007 Perceived personal similarity to the physician 0.00 (0.03) .88 0.19 (0.06) .002 0.18 (0.05) .001 0.31 (0.09) .001 Perceived ethnic similarity to the physician −0.00 (0.01) .91 0.01 (0.03) .80 −0.03 (0.03) .35 0.00 (0.05) .93
Supplemental Table
Supplemental Table. Items for the Patient Participation and Physician Patient-Centered Communication Measures
Files in this Data Supplement:
- Data supplement: Table - PDF file, 1 page, 79 KB
The Article in Brief
Background Are patients more likely to trust a doctor they view as similar to themselves? This study looks at patients' perceptions of concordance (similarity or shared identity) with their doctor based on race and sex. It also looks at whether views of similarity are connected to the patient-doctor relationship and quality of care, including patient participation in the medical visit, trust in the doctor, satisfaction with care, and intent to follow the doctor's advice. The study also tests a new tool to measure perceived similarity based on shared identity.
What This Study Found Patients who believe they are more similar to their doctor in terms of personal beliefs, values, and ways of communicating have more trust in the doctor, more satisfaction with care, and a stronger intention to follow the doctor's recommendations. Patients' perceptions of being similar to the doctor in terms of race and ethnicity are not related to these factors.
Implications
- The patient-doctor relationship is strengthened when patients see themselves as similar to their doctors in terms of personal beliefs, values, and communication.
- Regardless of issues of race and sex, a doctor who is skilled in providing information, showing respect, and supporting patient involvement can establish a connection with the patient that contributes to greater patient satisfaction, trust, and commitment to treatment.
- Future research should examine how similarities and differences in values, beliefs, and behaviors affect the quality of patient-doctor relationships.
Annals Journal Club Selection:
May/Jun 2008
The Annals Journal Club is designed to encourage a learning community of those seeking to improve health care and health through enhanced primary care. Additional information is available on the Journal Club home page.
The Annals of Family Medicine encourages readers to develop the learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club, and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for: Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care, and then acting on those discussions.1Article for Discussion
- Street RL Jr, O�Malley KJ, Cooper LA, Haidet P. Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity. Ann Fam Med. 2008;6(3):198-205.
Discussion Tips
The patient-physician relationship is the central element of family medicine, the family physician�s most potent instrument of healing and a centerpiece of the Future of Family Medicine Project.2 Yet, our ability to relate effectively to our patients is challenged the more we are different from our patients in any number of ways. The authors of this article attempt to further our understanding of the patient-physician relationship with regard to similarities and differences.Discussion Questions
- What questions are addressed by the article? Why do they matter?
- This study uses both quantitative (patient survey) and qualitative (analysis of audio-recording) data. How do the 2 data types work together to inform our understanding of patient-physician relationships? Which do you find more compelling?
- The study developed a 10-item scale to assess patients� perceptions of similarity to their physician. Does the scale measures what it intends? If not, what other steps might be used?
- What are the main findings?
- To what degree can the findings be accounted for by the following:
- The number of participating physicians?
- Ethnicity of participating patients and physicians?
- The study settings?
- Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a third factor)?
- Chance?
- How transportable are the findings to your practice setting? How might they be adapted?
- How might the study findings affect your approach to patients who are different from you?
- What are the implications of this study for medical education?
- What questions do you have for further research or application? How would you design a study to further our understanding of patient-physician relationships?
Reference
- Stange KC, Miller WL, McLellan LA, et al. Annals journal club: It�s time to get RADICAL. Ann Fam Med. 2006;4:196-197. Available at: http://annfammed.org/cgi/content/full/4/3/196.
- Martin JC, Avant RF, Bowman MA, et al. The future of family medicine: a collaborative project of the family medicine community. Ann Fam Med. 2004;2(Suppl 1):S3-S32.
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