When Rapport Building Extends Beyond Affiliation: Communication Overaccommodation Toward Patients with Disabilities

Abstract

Introduction: Physician rapport with patients is described as a vital component of relationship-centered care, but rapportbuilding communication behaviors may exceed boundaries and instead indicate patronizing behavior toward patients with disabilities. This paper addresses the types of communication behaviors and contexts for interpreting when rapport building extends beyond boundaries toward patients with disabilities.Methods: Videotaped interactions between third-and fourthyear medical students (N = 142) and standardized patient educators with physical disabilities were qualitatively analyzed.Results: Results suggest six primary themes of exceeding expected rapport boundaries, including baby talk (ie, exaggerated nonverbal gestures and "we" language to indicate "you"), kinesic movement (ie, stiff posture and awkward handshakes), vocalics (ie, volume or pitch that interfered with the flow of conversation), relationship assumptions (ie, communicating assumptions that relationships were grounded in care-receiving), emotional divergence from patient disclosure (ie, minimizing or embellishing disability), and inconsistency with patient emotional cues (ie, responding to negative or neutral disclosure by overly accentuating positive interpretation).Discussion: This study suggests that communication behaviors generally described as positive, rapport-building behaviors can pose negative implications when they exceed the expected quantity or duration, when they are inconsistent with patient verbal disclosure, or when verbal and nonverbal messages are inconsistent. Identified themes serve as examples to understand when rapport building exceeds beyond affiliation and instead appears to indicate patronizing behavior toward patients with disabilities. Suggestions for interpreting communication behaviors within the context of patient disclosure and building capacity to distinguish attitudes and biases limiting communication are addressed.

Cultivating inclusivity in precision medicine research: disability, diversity, and cultural competence

“…As other members of society, it is possible that stigma and unconscious bias about disabilities exist also among healthcare providers (Duggan et al 2011;McColl et al 2008). For example, research with healthcare providers found that many consider interactions with persons with disabilities, especially those with mental/psychosocial disabilities, to be more time-consuming and emotionally draining (McColl et al 2008;Stuart et al 2015).…”

“…Most many may attribute this outcome to individuals' inabilities to participate because of their specific conditions (e.g., questions surrounding the competency of people with intellectual and psychiatric conditions to consent to research participation). However, research in healthcare settings suggests that a lack of disabilityrelevant knowledge about accessibility and other sociocultural barriers (e.g., unconscious bias) may also play an important role in this underrepresentation in research (Duggan et al 2011;Mudrick et al 2012;Sneed et al 2000;Sanborn and Patterson 2014).…”

“…Yet, unlike other cultural competency expectations (see above), disability competency is not a core curriculum requirement for accreditation or receipt of federal funding (National Council on Disability 2009). Disability competency trainings in medical schools in particular (though also in other genomic-based programs) are subsequently limited (Duggan et al 2011;Sneed et al 2000;Sanborn and Patterson 2014;Madeo et al 2011). This lack of disability education may unintentionally lead to non-inclusive decisions by PMR personnel and IRB members that hinder the participation of people with disabilities in PMR.…”

Testing the Effects of Procedural Justice and Overaccommodation in Traffic Stops

“…In the medical context, overaccommodation has been found to result in negative perceptions of physicians. Although building rapport is an important aspect of improving interactions between patients and physicians, research has found that surpassing the appropriate degree of accommodation can be viewed negatively by patients with disabilities (Duggan, Bradshaw, Swergold, & Altman, 2011). In observing medical students’ interactions with patients with disabilities, Duggan et al (2011) found that “subtleties in the duration, range, or context of otherwise positive, rapport-building behaviors can have negative implications” (p. 28), which may be perceived as patronizing by patients.…”

“…Although building rapport is an important aspect of improving interactions between patients and physicians, research has found that surpassing the appropriate degree of accommodation can be viewed negatively by patients with disabilities (Duggan, Bradshaw, Swergold, & Altman, 2011). In observing medical students’ interactions with patients with disabilities, Duggan et al (2011) found that “subtleties in the duration, range, or context of otherwise positive, rapport-building behaviors can have negative implications” (p. 28), which may be perceived as patronizing by patients. The phenomenon of overaccommodation has also been reported in the customer service context (Ryan, Anas, & Gruneir, 2006) and between speakers of different languages (Platt & Weber, 1984).…”