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

Abstract

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 infl uenced by racial and sexual concordance and the physician's communication. METHODSThe 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. CONCLUSIONSThe 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.

Influence of language barriers on outcomes of hospital care for general medicine inpatients

“…Lastly, a more granular investigation of clinician-patient communication and the importance of interpersonal processes of care on both patient satisfaction and understanding of and adherence to discharge instructions could lead to the development of detailed interventions to enhance this communication and these outcomes as it has done for communication-sensitive outcomes in the outpatient arena. [32][33][34] In summary, our study suggests that higher risk for readmission can be added to the unfortunate list of outcomes which are worsened due to language barriers, pointing to transition from the hospital as a potentially ''communication-critical'' step in care which may be amenable to intervention. Our findings also suggest that this risk can vary even between groups of patients who do not speak English primarily.…”

Enhancing Health Communication Outcomes Among Ethnic Minority Patients: The Effects of the Match Between Participation Preferences and Perceptions and Doctor–Patient Concordance

“…Because it is possible that there is some variation in GPs' preferences depending on the individual patient, future research should measure concordance by means of separate doctor scores per patient. In addition, measuring patients' perceived concordance with the GP (Street, O'Malley, Cooper, & Haidet, 2008) instead of measuring concordance using separate doctor and patient scores might be an interesting avenue for future research too.…”

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

“…Organizations should seek to hire and retain a diverse workforce and should ensure that all staff, regardless of demographics, are trained and given the resources to provide culturally sensitive services. 42 Both racial and ethnic minority patients [42][43][44]92,93 and…”

“…However, clinicians who are 'discordant' can still build trust through patient-centered communication and the very act of encouraging SDM. 44 Relationship with the Community An organization's reputation and relationship with the communities it serves can strongly impact patient and provider attitudes toward SDM. 94 Organizations may need to do additional outreach with communities who have endured negative health care experiences based on their minority identities for these communities to expect that SDM is relevant and can work.…”