PT  - JOURNAL ARTICLE
AU  - Richard L. Street, Jr
AU  - Kimberly J. O’Malley
AU  - Lisa A. Cooper
AU  - Paul Haidet
TI  - Understanding Concordance in Patient-Physician Relationships: Personal and Ethnic Dimensions of Shared Identity
AID  - 10.1370/afm.821
DP  - 2008 May 01
TA  - The Annals of Family Medicine
PG  - 198--205
VI  - 6
IP  - 3
4099  - http://www.annfammed.org/content/6/3/198.short
4100  - http://www.annfammed.org/content/6/3/198.full
SO  - Ann Fam Med2008 May 01; 6
AB  - PURPOSE Although concordance by race and sex in physician-patient relationships has been associated with patient ratings of better care, mechanisms through which concordance leads to better outcomes remains unknown. This investigation examined (1) whether patients’ perceptions of similarity to their physicians predicted their ratings of quality of care and (2) whether perceived similarity was influenced by racial and sexual concordance and the physician’s communication. METHODS The research design was a cross-sectional study with 214 patients and 29 primary care physicians from 10 private and public outpatient clinics. Measures included postvisit patient ratings of similarity to the physician; satisfaction, trust, and intent to adhere; and audiotape analysis of patient involvement and physicians’ patient-centered communication. RESULTS Factor analysis revealed 2 dimensions of similarity, personal (in beliefs, values) and ethnic (in race, community). Black and white patients in racially concordant interactions reported more personal and ethnic similarity (mean score, 87.6 and 78.8, respectively, on a 100-point scale) to their physicians than did minority patients (mean score, 81.4 and 41.2, respectively) and white patients (mean score, 84.4 and 41.9, respectively) in racially discordant encounters. In multivariable models, perceived personal similarity was predicted by the patient’s age, education, and physicians’ patient-centered communication, but not by racial or sexual concordance. Perceived personal similarity and physicians’ patient-centered communication predicted patients’ trust, satisfaction, and intent to adhere. CONCLUSIONS The physician-patient relationship is strengthened when patients see themselves as similar to their physicians in personal beliefs, values, and communication. Perceived personal similarity is associated with higher ratings of trust, satisfaction, and intention to adhere. Race concordance is the primary predictor of perceived ethnic similarity, but several factors affect perceived personal similarity, including physicians’ use of patient-centered communication. Annals Journal Club selection—see inside back cover or http://www.annfammed.org/AJC/.