Communication study
Obese patients overestimate physicians’ attitudes of respect

https://doi.org/10.1016/j.pec.2011.12.010Get rights and content

Abstract

Objective

To evaluate whether obese patients overestimate or underestimate the level of respect that their physicians hold toward them.

Methods

We performed a cross-sectional analysis of data from questionnaires and audio-recordings of visits between primary care physicians and their patients. Using multilevel logistic regression, we evaluated the association between patient BMI and accurate estimation of physician respect. Physician respectfulness was also rated independently by assessing the visit audiotapes.

Results

Thirty-nine primary care physicians and 199 of their patients were included in the analysis. The mean patient BMI was 32.8 kg/m2 (SD 8.2). For each 5 kg/m2 increase in BMI, the odds of overestimating physician respect significantly increased [OR 1.32, 95%CI 1.04–1.68, p = 0.02]. Few patients underestimated physician respect. There were no differences in ratings of physician respectfulness by independent evaluators of the audiotapes.

Conclusion

We consider our results preliminary. Patients were significantly more likely to overestimate physician respect as BMI increased, which was not accounted for by increased respectful treatment by the physician.

Practice implications

Among patients who overestimate physician respect, the authenticity of the patient–physician relationship should be questioned.

Introduction

A core element of the patient–physician relationship is respect, which has been defined as “the recognition of the unconditional value of patients as persons” [1]. Beach et al. showed that physician respect varies across patients [2]. The same study found that physicians exhibited different communication behaviors during encounters with patients whom they respected, such as sharing more information and having a more positive emotional affect [2]. Although the philosophical ideal of respect should be independent of a patient's personal characteristics, studies have shown that increased patient body mass index (BMI) is negatively associated with physician respect [3] and multiple studies document health professionals’ overall negative regard toward patients with obesity [4], [5], [6], [7], [8], [9].

Despite negative provider attitudes, other studies find that obese patients are satisfied with their healthcare providers [10], [11], [12], [13]. These paradoxical findings may result from patients’ inability to accurately perceive providers’ negative regard. Societal discrimination toward obese persons is common in work, educational and social settings [14], [15]. Therefore, we theorize that obesity may alter a person's ability to accurately perceive the attitudes of others during interpersonal interactions, either through desensitization or over-sensitization to disrespectful behaviors. For example, if an obese patient is desensitized to disrespectful behaviors, then he/she may interpret biased treatment from their physician as normal, and consequently overestimate physician respect. Conversely, a patient who has heightened awareness of any disrespectful attitude may underestimate physician respect. This idea of inaccurate estimation of physician attitudes among obese patients is supported by work from Brandsma [16]. In Brandsma's study, dyads of physicians and their obese patients were recruited to participate in a survey about general attitudes regarding obesity. When physicians’ attitudes were compared to how their patients perceived the physicians’ views, the patients perceived less positive attitudes than those reported by physician. This survey asked questions regarding attitudes toward obese individuals in general, and did not ask about physician attitudes toward the patient surveyed. To date, no studies have compared patient and physician perspectives to evaluate how obesity impacts the patient's ability to accurately estimate his/her physician's level of respect.

Obese patients’ ability to accurately estimate their physicians’ attitudes may have implications regarding the authenticity of these patient–physician relationships. Beach and Inui conceptualized authenticity as the physician not only acting respectfully toward a patient, but also actually having respect for that patient [17]. Arnason described an authentic conversation as when patient and physician participate in a dialog in which the subjectivity of both is respected [18]. While the association between authenticity and patient outcomes has yet to be evaluated, authenticity is considered an ethical principle in patient–physician relationships [17], [18]. Authentic conversations may facilitate shared decision-making and reduce alienation between patients and physicians [18]. If obese patients are not able to accurately estimate their physicians’ regard, then the authenticity of these patient–physician relationships may be compromised.

In this study, we aimed to justify our theory that obesity alters one's ability to accurately perceive the attitudes of others during interpersonal interactions by examining whether patients’ weight influences their ability to accurately estimate levels of physician respect. We hypothesized that higher patient BMI would be associated with both overestimation and underestimation of physician respect. In addition, we assessed the level of physician respect as rated by an independent third party, in order to assess differences in physician respectfulness that may have contributed to over- or underestimation of respect.

Section snippets

Study design, subjects, and setting

We carried out a cross-sectional study by performing a secondary analysis of data from the baseline visit of the Patient–Physician Partnership Study (Triple P study). The Triple P study was a randomized controlled trial of a patient–physician communication intervention to improve patient adherence and blood pressure control [19]. The study included urban, community-based primary care physicians seeing their established patients for routine follow up. Primary care physicians were recruited from

Results

Table 1 shows the descriptive characteristics for 199 patients in the study sample. Overall, the mean patient BMI was 32.8 kg/m2 (SD 8.2). Table 1 displays the distribution of patient BMI according to the NIH standard classifications of weight. The majority of patients were women (63%) and black (61%). Table 2 shows the descriptive characteristics for the 39 physicians in the study sample. The majority of physicians were female (54%).

In the main analysis, 124 patients accurately estimated

Discussion

In this study, we found that overestimation of respect was significantly associated with increasing BMI. These results support our theory that obese patients may overestimate physician level of respect, which we hypothesized may be due to past experiences that have desensitized them to disrespectful behaviors. Underestimation of respect occurred infrequently. Overestimation of physician respect is unlikely to be a consequence of overly respectful physician behaviors, as there was no difference

Acknowledgments

This work was supported by grants from the National Heart, Lung, and Blood Institute (L.A.C.; R01HL069403, K24HL083113) (M.C.B.; 5RO1HL088511-02) and the National Center for Research Resources (M.M.H.; 1KL2RR025006). K.A.G. was supported by a training grant from the Health Resources and Service Administration (T32HP10025-16-00). K.A.G. had full access to study data and takes responsibility for the accuracy of the analysis. The authors declare no conflict of interest.

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