NYT: Do the 'ties that bind' doctors and patients improve care?

'We will, for better or worse, always see ourselves in some patients'

Writing in the New York Times' "Well" blog, internist Abigail Zuger explores whether doctors are more effective when they care for patients that remind them of themselves.

"Professional training may not remove the interpersonal chemistry that binds us to some and estranges us from others, but it can neutralize these forces somewhat, enough to enable civilized and productive dialogue among all comers," Zuger writes. But, she adds, "we will, for better or worse, always see ourselves in some patients, our friends and relatives in others, and our patients will likewise instinctively experience doctor as mother or father, buddy, or virtual stranger."

When nurses become attached to their patients

So, she asks, "Are the ties that bind us for better, medically, or are they for worse? Is health care more effective when patient and doctor are the same—the same sex, class, race, tax bracket, sore feet, and cholesterol level?"

Some research has examined the effect of race on doctor-patient relationships. A 2010 study found black patients were more likely to adhere to medication guidelines when they were recommended by a black doctor, although the same did not hold true for Asian patients and physicians. Meanwhile, a 2003 study found when patients and physicians were the same race, general medical visits lasted longer and patients felt a bit happier than when their races were different.

However, "the results are all over the place" when researchers focus on actual health outcomes, Zuger writes. A 2013 study found that similarities or differences in race had no effect on a patient's blood pressure, but how much the patient trusted the physician did.

Meanwhile, a 2012 review of 10 years' worth surveys found that most women preferred female gynecologists because they believed women communicated better than male physicians. However, Zuger offers an anecdote in which a patient sought out a male gynecologist because her female gynecologist appeared to underestimate the patient's pain based on her personal experience.

One study suggests that appearance may make a difference when it comes to weight loss. Overweight patients deem weight loss advice more significant and trustworthy when it comes from an overweight physician, according to a 2012 study.

Do overweight physicians avoid their patients' weight problems?

Beyond the external similarities, Zuger notes that doctors and patients can also related on an emotional or intellectual level. "Impossible to measure, and hence impossible to study, are the real cues—the twitch of a lip or turn of phrase—that tell two humans they are members of the same psychic quasi species," she writes.

Overall, Zuger urges against making assumptions about how the similarities and differences between doctors and patients affect health outcomes.  

"We know that pairings between like-minded individuals make life worth living and populate the planet. We assume they make health care a more pleasant process. What they do to its outcome, we have no clue," she concludes (Zuger, "Well," New York Times, 5/19).

Navigating a doctor-patient relationship

See our archive of articles on doctor-patient relationships, including:

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