Disentangling Evidence and Preference in Patient-Clinician Concordance Discussions

Abstract

Debate about whether and when to accommodate patient requests for concordant clinicians should consider evidence. This article examines how existing evidence could be used to interpret or inform ethical arguments about whether to accommodate such requests. Studies on patient-clinician concordance yield mixed and inconclusive results. Concordance might contribute to increased patient satisfaction and trust, but these results are not consistent and could be the result of clinicians' communication skills. Given this evidence and the risk of social harm in honoring concordance requests, this article argues that patients' concordance requests should be honored only when health care services would be denied to a patient, such as in a case of a clinician's conscientious objection to providing a service. All other requests should be scrutinized for a reasonable ethical justification. Concordance Requests In this article, we review evidence about patient-clinician concordance-that is, shared characteristics like gender, race, or socioeconomic status-and discuss how it bears on the debate about whether to accommodate patients' requests for clinicians with specific characteristics. Patients may request a clinician with a specific characteristic for a variety of reasons, including personal preference, religious values, or assumptions about who provides the best care. Some might argue that patients, as the vulnerable party, ought to have their requests accommodated but draw a line when preferences are based on socially unacceptable reasons grounded in prejudice, sexism, or racism.

Youth preferences for healthcare providers and healthcare interactions: a qualitative study

“…However, overall, the percentages of non-white youth and youth overall reporting that racial concordance was important was relatively low (16% and 8% respectively), with some youth reporting explicitly that it was not important. Evidence from past studies is mixed on the impact of concordance on healthcare [ 20 , 33 , 34 ], with the exception of language concordance [ 35 , 36 ]. Healthcare providers may better engage and support youth as they develop more independence in their own healthcare if youth are provided options and are guided in selecting a provider that would be a good fit.…”

Improved Patient Experience and Outcomes: Is Patient–Provider Concordance the Key?

“…Although most studies consider only one aspect of concordance, a 2019 study by Rand and Berger combined patient–provider racial, gender, and value concordance in their consideration of the logistical and ethical impact of accommodating patients' requests for specific providers ( 4 ). While their study included different forms of patient–provider concordance, the review did not evaluate the interconnection of racial and gender concordance, as well as the potential cumulative effect of multiple shared traits ( 4 ). This review focuses on the individual and combined impact of racial, gender, and multifactorial concordance on patient experience and outcomes.…”

“…Therefore, some researchers have explored how well this racial connection translated into the patient experience. During patient visits that often involve increased vulnerability or a need for guidance, most people may find comfort in turning to someone who looks like them, speaks like them, and understands their background ( 4 ).…”

“…As many of the reviewed studies highlighted, further research in this domain is required to determine if patient–provider concordance is associated with improved patient experience and outcomes. Due to the current lack of diversity amongst healthcare providers, advocating for patient–provider concordance without conclusive evidence may lead to harmful outcomes, including exacerbation of health disparities, “increased stereotyping, social segregation, and xenophobia.” ( 4 ) Therefore, in addition to promoting further research, many studies supported some combination of cultural competency, cultural humility, and communication training for graduate medical students and practicing providers ( 9 , 11 , 14 , 29 – 32 ). Although promising to know that patient-provider concordance may not be required to achieve positive patient experiences and outcomes, many may contest that it is difficult or even impossible for providers to obtain these skills within a homogenous classroom setting.…”