Search all of the Society for Participatory Medicine website:Search

Abstract

Summary: This study adopted survey research and focus group discussion methods to ascertain whether ethnicity affected interpersonal communication between doctors and patients. The objectives of the study were to find out if language is a factor in determining respondents’ interpersonal communication relationship with a doctor; to find out if there is a relationship between a doctor’s ethnic background and respondents’ attitude towards interpersonal communication on serious illnesses; and to ascertain whether there is a difference in male and female respondents’ perception of the relationship between a doctor’s ethnic background and interpersonal communication on serious illnesses. A sample size of 300 was used for the study. We found the ethnicity of a doctor significantly affected the nature of interpersonal relationship between the doctor and a patient.
Keywords: Ethnicity, communication, doctor-patient communication, interpersonal communication.
Citation: Nwabueze C, Nwankwo NN. Ethnicity and doctor-patient communication: an exploratory study of University of Abuja Teaching Hospital, Nigeria. J Participat Med. 2016 Oct 7; 8:e12.
Published: October 7, 2016.
Competing Interests: The authors have declared that no competing interests exist.

Introduction

A doctor’s communication and interpersonal skills encompass the ability to gather information in order to facilitate accurate diagnosis, counsel appropriately, give therapeutic instructions, and establish caring relationships with patients. The ultimate objective of any doctor–patient communication is to improve the patient’s health and medical care. [1]

Effective doctor–patient communication is determined by the doctor’s “bedside manner,” which patients often judge as an important indicator of the doctor’s general competence. Good doctor–patient communication has the potential to help regulate patients’ emotions, facilitate comprehension of medical information, and allow for better identification of patients’ needs, perceptions, and expectations.[2]

The concept that ethnicity has a significant influence on the interaction of doctors and patients is new. When there is a need to settle a health challenge, patients tend to feel more relaxed with doctors from certain ethnic groups.[3] This preference may arise as a result of the nature of the illness to be treated, as some may want to use their native language to communicate about certain topics.[4]

The personal interview is the major medium of health care. Most of the medical encounters are spent in communication between practitioner (doctor) and patient. The interview has three functions: gathering information, developing and maintaining a therapeutic relationship, and communicating information.[5]

The negotiation of a shared orientation between doctor and the patient takes place through a series of exchanges, until the doctor is finally able to match the patient’s problem to a medical diagnosis. As a result, some patients decide or prefer to see doctors who communicate effectively with them.[6]

Goold and Lipkin note that effective use of language in communication gives patients a sense that they have been heard and allowed to express their major concerns, as well as denoting respect, caring, empathy, self-disclosure, positive regard congruence, and understanding. [5] This allows patients to express and reflect their feelings and relate their stories in their own words. Interestingly, actual time spent together is less critical than the perception patients reach that they have a good level of understanding in the communication.

Doctors are specially trained to investigate and find solutions to all kinds of ailments. Although they specialize in different sub-fields of medicine such as paedriatics, gynaecology, obstetrics, orthopaedics, surgery, etc, some doctors take the role of general practitioners to attend to patients with various kinds of complaints of ill-health in the Out-Patients Departments (OPD) and casualty departments.[7] Part of the training of medical doctors includes medical ethics, medical history and practice and medical communication with both personnel and patients. [1] There are those well prepared to understand the diagnosis, prognosis, treatment and follow-up of sick patients and also to do their best to use effective communication (not minding what lingua franca they use) to get every necessary detail.

Adegbite and Odebunmi noted that the nature of diagnostic interaction is consultative. [8] The medical doctor has a view to diagnosing the patient’s problem. During the process, the physician takes notes on his/her observations and prescriptions (ie a medical report) for treating of the case in a medical file meant for the clients. Adegbite and Odebunmi further noted that the client is either a sick person, ie a patient, or the parent(s) or relations of a sick person and the doctor controls the interaction by dictating the pace of conversational turn-taking. He or she can interrupt at will and use dominant acts such as directives, accusations and caution to check the clients during interaction. For the successful achievement of diagnosis and medication, the client must have confidence in the medical system. Such confidence is built around the personality and care of the doctor and other medical personnel.[3]

Communication between a doctor and his or her patient appears critical to the establishment of the therapeutic relationship and the patient’s willingness to remain in care.[9] It is possible that some patients might prefer their doctors to come from another ethnic group, and that under certain circumstances they might trust someone who did not speak their language more than someone who does. Street identified four major communication-related factors that might contribute to negative outcomes in doctor-patient relationship such as misunderstanding, lower satisfaction, and reduced compliance. [10] These factors, according to Street, are where ethnically discordant patients and providers: a) speak different languages or dialects; b) have different preferred styles of communicating in medical encounters; and c) operate out of different explanatory models of health and illness. These factors affect patient outcomes directly or indirectly and influence the level of trust that patients have on providers. [3] It is against this backdrop that this study seeks to ascertain whether the ethnicity of doctors influences their interpersonal therapeutic and diagnostic communication with the patients.

Statement of Problem

Patients are the core purpose of establishing hospitals and the sole aim of training doctors. Communication between physicians and patients is fundamental to medical care.[11]

Language barriers may lead doctors to overtreat patients, sending patients for additional tests and procedures that increase the cost of care and may pose additional risks to the patients.[6] Patients’ perception about health care providers from a particular ethnic group can also affect his/her preference, relationship and communication with the doctor.[13][14]

The conversation between physician and patients has long been recognized to be of diagnostic import and therapeutic benefit.[6] But can we say that patients and doctors of different ethnic groups may freely relate with regard to diagnostic and therapeutic communication?

Without effective use of language, the physician-patient relationship is seriously impaired.[6] At the conclusion of a commentary on the patient/doctor relationship, from the patient’s perspective, Farragher stated that the quality of the rapport between doctor and patient influences wellness. [15] The piece also stated that respectful, trusting relationships motivate people to follow recommendations to help prevent or remedy illness.

This study therefore explores the doctor-patient communication at the University of Abuja Teaching Hospital with a view to examining how ethnic differences influence interpersonal relationship between doctors and patients in the hospital. Studies of this nature are scarce in Nigeria and this study intends to fill that gap in literature.

Objectives of Study

The study seeks to:

  1. Find out if language is a factor in determining level of respondent’s interpersonal communication with a doctor.
  2. Find out if there is a relationship between a doctor’s ethnic background and respondent’s attitude towards interpersonal communication on serious illnesses.
  3. To determine whether there is a difference in male and female respondents’ perception of the relationship between a doctor’s ethnic background and interpersonal communication on serious illnesses

.

Research Questions

  1. Does language serve as a factor in determining patient’s interpersonal communication with a doctor?
  2. What is the relationship between a doctor’s ethnic background and patient’s attitude towards interpersonal communication on serious illnesses?
  3. Do male and female patients perceive the relationship between doctor’s ethnic background and interpersonal communication on serious illnesses the same way?

Theoretical Framework

In studying ethnicity and doctor-patient communication, we considered two theories that are relevant to this study – Uncertainty Reduction Theory and Community Privacy Management theory.

Uncertainty Reduction Theory.

The Uncertainty Reduction Theory posits that people often feel uncertainty about others they do not know; to reduce that uncertainty, they are motivated to communicate and gain information about them. The theory was proposed by Charles Berger and Richard Calabrese in 1975.[16][17] It states that when encountering a new person or group of people, we move through three different phases of discovery: Entry, Personal, and Exit.[18] The end goal of this process is to build a level of understanding so that we can more easily predict the other’s behavior, thereby reducing uncertainty and discomfort.

Ormanova further explained that in the entry phase, communication is regulated by commonly accepted social rules. [18] People may shake hands or engage in other customary nonverbal greetings; introduce themselves either in a casual or a formal fashion, or engage in polite generalities of conversation, etc.

The personal phase begins when the engaged parties begin to feel relaxed and start to share information more freely.[18] The exchange of dialogue in the personal phase will allude to beliefs and values without addressing any contentious issue. The final phase of this process is the exit phase; here people decide whether they want to continue to develop their relationship. If there is no mutual liking, they can choose not to pursue a relationship.[17]

Uncertainty Reduction Theory has been applied to new relationships in recent years. Although it continue to be widely respected as a tool to explain and predict initial interactions and events, it is now also employed to study inter-cultural interaction,[19] organizational socialization and as a function of media.[16] Research evidence has shown that uncertainty plays a vital role in shaping provider-patient interaction as patients face uncertainty, including symptom attribution, state of the illness, treatment options and prognosis, social roles and the potential effect of the illness on friends, family, and personal long-term plans.[20]

Uncertainty Reduction Theory (URT) was originally developed to explain initial communicative interactions between strangers.[16] This theory basically assumes that an individual’s primary goal in initial communication is to increase predictability and decrease uncertainty of one’s own behaviors and those of others. Individuals do so by striving to predict communication behaviors of themselves and others before an interaction and retroactively seeking to explain behavior after the interaction. [16]

This theory therefore relates to this work in the area of interpersonal communication between doctors and patients. Patients come to the hospital and have the privilege of a diagnostic interaction with the doctor they see. At this point, patients may prefer to withhold vital information about their illnesses or release such information on gradual basis. This could be as a result of their skepticism about ethnic differences.

Communication Privacy Management Theory

This theory, according to Petronio, is concerned with how people negotiate openness and privacy with regard to communicated information. [21] This theory focuses on how people in relationships manage boundaries that separate the public from the private.

According to the theory, a person’s private information is protected by personal boundaries. The permeability of these boundaries are ever changing, and allow certain parts of the public access to certain pieces of information belonging to the individual. Disclosure and sharing of information takes place after individuals weigh their need to share the information against their need to protect themselves. The disclosure of private information to a partner could lead to greater intimacy, but it may also result in the discloser becoming more vulnerable.[22][23]

Communication Privacy Management Theory is a “homegrown” communication theory based on systematic research designed to develop evidence and understanding of the way people regulate revealing and concealing information.[22][23] On initial encountering, the theory posits it is helpful to leave previously held beliefs about disclosure behind. Unlike earlier theories, Communication Privacy Management Theory views “disclosure” as the process of revealing private information. Since these two concepts are in a dialectical tension with each other, the way revelation takes place is through a rule management system. This notion shifts the frame from focusing only on “self disclosure,” capturing both the elements of privacy and the process of disclosure. Petronio further argued that “the theory makes private information, as the content of what is disclosed, a primary focal point.” [24] Communication Management Theory also depends on the notion of boundaries to give us a way to conceptualize how the management process works.

In relation to this work, this theory deals with the disclosure of private information and this is relevant to how doctors are able to break through patients’ personal medical boundaries through communication. This process can only happen when patients have weighed their need to share all the information the doctor needs for therapeutic communication. It is possible that patients in the University of Abuja Teaching Hospital reveal or conceal information on health matters based on cultural similarities or differences with the doctors.

Literature Review

Disparities in Health Care Delivery: Cultural Context Overview

Cultural competence and patient-centeredness are approaches to improving health care quality that have been promoted extensively in recent years.[25] As they have gained recognition and popularity, however, considerable ambiguity has evolved in their definition and use across settings.

The ability and preparedness of health care providers to engage in effective interactions with patients depends in large part on the providers’ knowledge, attitudes, skills and behaviors.[26] At the core of both patient-centeredness and cultural competence is the ability of the health care providers to see the patient as a unique person; to maintain unconditional positive regard; to build effective rapport; to use psychosocial models to explore the patient’s beliefs, values and meaning of illness, and to find common ground regarding treatment plans.

Racial and ethnic disparities in health quality have been extensively documented. Much of this literature has focused on technical aspects of health care, such as whether or not patients receive appropriate tests, procedures, or medication.[27] However, there is also increasing evidence that racial and ethnic minority patients receive lower quality interpersonal care than white patients. In 2002, the Institute of Medicine reported that unequal ethnical disparities in health care in the U.S. are not entirely explained by differences in access and clinical appropriateness. It seems that disparities in health care exist in the broader historical contemporary context of social and economic inequality, prejudice and systematic bias.[28] Saha et al further explained that the literature that documents disparities in health and health care for other ethnic minority groups has also grown. [26] To the extent that ethnicity describes national origin and language in addition to culture and social status, its role in producing disparities may be distinct from that of race.

The consistency of patterns of disparity in different aspects of society supports the argument that a common underlying set of mechanisms exists through which race and ethnicity affects inequalities in health care and health status.[29]

Racial and Ethnic Concordance.

While racial and ethnic disparities in health services may be attributed to a variety of structural and social processes, one especially persistent source of disparities in mental health care is the failure of physicians to retain minority patients in treatment after an initial visit.[30] Communication during the intake session appears critical to the establishment of a therapeutic relationship and the patient’s willingness to remain in care.[9] Examining the experience of minority patients, most commonly with a physician of a different ethnic/racial background, the Commonwealth Fund’s health care quality survey found that racial and ethnic minority patients report more communication problems with their physicians.[31]

Research suggests that patient–doctor consultations that are discordant in terms of race, ethnicity, or language are characterized by less participatory decision–making, lower levels of patient satisfaction, and higher rates of miscommunication, even after adjusting for markers of socioeconomic status.[32] As a result, it has been postulated that an ethnic/racial match between doctor and patient may result in superior outcomes.[32] Goold and Lipkin found ethnic/racial matching to be associated with longer retention in treatment among multiple minority groups, with the notable exception of African–Americans. [5] This success is attributed to better rapport and comfort between concordant patient–doctor dyads, resulting in greater patient satisfaction.[32]

Race/Ethnicity and Doctor-Community Relationship.

The nature of health care providers’ relationships with the communities that they serve remains largely unexplored. However, a significant body of literature examines the characteristics of primary care, particularly for under-served communities. [9] These studies have shown that doctors’ ethnicity, family, background, training, and economic factors are related to their care of ethnic minority and under-served communities. [31]

Ethnic minority doctors are more likely to care for patients of their own race or ethnic group. [13] They may practice in underserved areas or care for poor patients and those who report poor health status and use more acute medical services such as emergency rooms and hospital care.

A study on doctor-patient communication in hospitals in Ibadan found that there was increasing evidence that racial and ethnic minority patients receive lower quality interpersonal care than white patients. [33] The work discovered that ethnicity-based therapeutic relationships and disparities have a lasting influence on the extent of medical care a patient receives.

Another study on understanding concordance in patient-physician relationships found that concordance by race (but not sex) contributed in varying degrees to patients’ perceptions of a shared identity with their physicians, a perception that appears to be an important part of the physician–patient relationship. [34] The perception of similarity to one’s physician is a multidimensional construct with some components more strongly related to outcomes than others. According to the study, patients who believed they were more similar to their doctor with respect to personal beliefs, values, and ways of communicating reported more trust in the physician, more satisfaction with care, and stronger intention to adhere to recommendations.

The work discovered that physicians’ use of patient-centered behavior was related to patients’ beliefs that they and the physician achieved a common understanding of their health conditions. The study also found that a physician who is skilled in informing, showing respect, and supporting patients’ involvement can transcend issues of race and sex to establish a connection with the patient, and this in turn contributes to greater patient satisfaction, trust, and commitment to treatment.

English is oftentimes used in medical communication in Nigeria. The communication between doctors and patients could be generally classified as formal consultative or informal. In most communities in Nigeria and the nation’s state capital Abuja, English, a major official language of the country, is combined with indigenous language, the unofficial language of the people. [33] In Abuja the languages used are diverse and the doctors also of various tribes.

In hospital interactions, the goal is to register the transaction and interaction function of language, together with the speech acts that accompany each function with interpersonal features. Speaking English or any language intelligible to both the doctor and the patient, can establish and cement relationships; the tone may be casual, cordial or professional. [33] Medical practitioners and other workers greet each other, ask after colleagues and families, and sometimes make jokes to kill time and boredom etc. The same gesture is extended to patients. If the patient speaks or can speak English he/she is greeted and ushered in English. [33] [4]

University of Abuja Teaching Hospital: An Overview

The University of Abuja Teaching Hospital (UATH) was established as a specialist Hospital in 1982 under the Federal Development Authority, FCDA. It was changed to Federal Capital Medical Centre in 1993 following its transfer to Federal Ministry of Health. It is located in Gwagwalada, Abaji Area Council, Abuja, Nigeria. In September 2006, the Hospital upgraded to a Teaching Hospital for the University of Abuja.

The Hospital is the only Teaching Hospital Located in Gwagwalada in the federal Capital Territory of Nigeria. It is a 350-bed hospital with facility for expansion to 500 beds.

Operational Definition of Terms

Patients: The different people that have been treated or are being treated for illness in University of Abuja Teaching Hospital, Gwagwalada Abuja;
Doctors: The physicians that work in University of Abuja Teaching Hospital;
Ethnicity: The parts of Nigeria which people studied in this work come from – East, West, North, South and Middle belt;
Language: The medium of communication (English, Yoruba, Igbo, Hausa, etc.) used by the doctors and patients at the University of Abuja during interaction;
Serious Illness: Health conditions like cancer, tuberculosis, Sexually Transmitted Disease (STD) etc. experienced by patients at University of Abuja Teaching Hospital;
Unserious Illness: Other forms of health conditions such as fever, cough, catarrh, etc. which the University of Abuja Teaching Hospital patients report to doctors in the hospital;
Doctor-Patient Communication: The interaction between a doctor and patients at the University of Abuja Teaching Hospital;
Doctor-Patient Relationship: The association between a doctor and patient at the University of Abuja.

The Method

The survey and focus group discussion methods were used in this study. Thus, a representative sample of people in Abuja who have been treated and are undergoing treatment in University of Abuja Teaching Hospital were surveyed to determine the level of relationship and communication that patients have with doctors, considering ethnicity as a major factor.

Several groups of patients of University of Abuja Teaching Hospital were met and asked some questions on how they related with doctors from other ethnic groups and those from their ethnic background, including how this affected their relationship and understanding with the doctors.

The area of study was Gwagwalada in Abaji Area council in Abuja the Federal Capital Territory of Nigeria. It has a federal institution, University of Abuja, which has a Teaching Hospital that is the focus of study. It is mostly dominated by civil servants and students with visible commercial and educational activities.

In this study, the population is the number of patients who have been treated or are still undergoing treatment in University of Abuja Teaching Hospital Gwagwalada. The period of study was January to June 2015. This means that people who had visited the University of Abuja Teaching Hospital during this period were identified purposively and selected for the study. The choice of January to June 2015 as the period of study was discretionary.

A sample size of 300 was selected for the study. This was done according to the guideline provided by Wimmer and Dominick for multivariate studies as follows: 50= very poor, 100= poor, 200= fair, 300=good, 500= very good, 1000= excellent. [35]

This study used the purposive sampling technique since this technique permits the researcher to target the specific characteristics she wants to study. This implies that not all available individuals in the population have the characteristics needed for the research. For instance, in this study, only patients who had undergone treatment between January and June 2015 and had undergone consultation with a doctor in the hospital were qualified.

In this study, two methods were used for the data collection. The questionnaire was employed as the instrument to generate information from a total of 216 respondents. The remaining 84 respondents participated in the group discussion sessions. Six (6) focus group discussion sessions were held with each group comprising of 14 persons. The respondents in the group were from different ethnic groups, reflecting the multi-ethnic nature of residents of Abaji area council.

The use of questionnaire interview guide was used to get information and required data from the sample (ie, patients). The questionnaires were distributed to patients that have been and are also being treated in the hospital. The researchers went further to have face-to-face discussion with patients who shared their views and answered the questions (see Table 2).

In this study, 230 copies of the questionnaire were distributed to the respondents for their response. Out of 230 copies of questionnaire distributed, 210 copies were returned and found usable and valid. This represents a 95% return rate, while the 20 copies not returned represented 5% not reliable for the study.

The demographic characteristic of respondents showed that 15 respondents representing 7.1% fall within the age bracket of 15-25 years, 43 of 20.5% fall within 25-35 years, 59 (28%) accounts for 35-45 years and 27 (12.9%) within 55 years and above.

The sex distribution indicates that 83 (39.5%) of those who filled the questionnaire are male while 127 (60.4%) are female; 25 (11%)are single, 150 (71.4%) are married while 35 (16.6%) are divorced. In our study, 20 (9.5%) of the respondents communicated with the doctor in Igbo language, 26 (12.3%) in Yoruba, 39 (18.6%) in Hausa, 80 (38%) in English and 45 (21.4%) in other languages which include Nupe, Calabar, Igala and Urhobo.

Findings

Answering Research Questions

(Data from Survey Method)

Research Question One
Does language serve as a factor in determining patient’s interpersonal relationship with a doctor?

Table 1. Respondents view on difference in doctor’s ethnic background.
nwabueze-table-1

The above table reveals that out of 230 respondents sampled, 150 (71.4%) indicated that difference in the doctor’s ethnic background affects their relationship with them while 60 (28.5%) responded that the doctors ethnic background does not affect their relationship with him.

Research question two
Is there a relationship between a doctor’s ethnic background and patient’s attitude towards interpersonal communication on serious illnesses?

Table 2. Respondents’ perception on how free they are to release intimate information on serious illnesses.
nwabueze-table-2

The above table shows that 131 (62.3%) of respondents said they felt free to release more information when they find out that the Doctor is from their ethnic background, while 79 (37.6%) respondents said that they did not.

Research Question Three
Do male and female patients perceive the relationship between the doctor’s ethnic background and interpersonal communication on serious illnesses the same way?

Table 3. Gender influence on perception of respondents on how free they are to release intimate information on serious illnesses.

nwabueze-table-3

The above table shows that 35 (42%) of males said they felt free to release more information when they find out that the doctor is from their ethnic background, 48 (57.8) male said that they do not, while 96 (75.5) females said they do, and 31 (24.4) females said they don’t feel free.

Data from Focus Group Discussion

Six groups of 14 persons each were interviewed. These persons were not part of those who completed the questionnaire copy for the study. They made up a separate group set apart for the group discussion data-gathering technique. The demographic data of the participants of the group discussion sessions showed that 17 respondents were between 25-35 years of age, 32 were between the ages of 35-45, 21 respondents were between the ages of 45-55 years of age. The gender classification above shows that 28 (40%) of the respondents were males while 42 (60%) of them were females. The tribal background of the respondents showed that they were from different ethnic groups. Apart from Igbo, Hausa and Yoruba, other ethnic groups include Nupe, Calabar and Urhobo.

In group discussions with patients, the researchers found out that patients visited the hospital for different level of illness. The majority of the patients said that very serious illnesses brought them to the University of Abuja Teaching Hospital. Some were very open and mentioned their diagnoses, including diabetes, high fever, pneumonia, etc. while some kept this to themselves. Other respondents said they went to the hospital as a result of minor illness.

Answers to Research Questions

Research Question One.
Does language serve as a factor in determining patient’s interpersonal communication relationship with a doctor?
Most of the respondents said they interacted with the doctor in English while the rest said they did so in their native language. One of the respondents, Mr. Akinwolu (not his real name), said that he spoke Yoruba with the Yoruba doctor he met, but on a second visit he met another doctor from another ethnic background (Calabar). He then had to switch to the English language. He said he was not happy with this development but he had to go ahead and speak with the doctor. In the words of Akinwolu, “I had spoken with a Yoruba doctor the first time, only to come again and see another doctor from a different tribe. I had felt relaxed speaking with a doctor from the Yoruba ethnic group.” The respondents were of the opinion that though they often communicated with their doctors in English, they felt more relaxed and willing to share more information if they spoke their native languages with a doctor.

In the interactive session with the respondents, the researcher found that among the 84 respondents, all apart from 8 knew the tribe of the doctor they saw and they further explained that they discovered this through their accent and written names. In all five discussion groups, most of the respondents, about 60 of them, agreed that the doctors’ ethnicity had a role to play in their relationship with the doctor while the remaining few disagreed to this.

Those who disagreed said they were more interested in the experience and expertise of the doctor, not his or her ethnicity. They argued that a doctor’s ethnicity does not translate to his or her ability to diagnose an illness effectively. Some of them said due to the dwindling educational standard in Nigeria which had also affected medical training, they preferred elderly doctors to younger doctors in terms of age. Here, the age of the doctor played a more important role in doctor-patient communication than ethnicity.

Research Question Two
What is the relationship between a doctor’s ethnic background and a patient’s attitude towards interpersonal communication on serious illnesses?
This question was asked of respondents in the group discussion sessions who had visited University of Abuja Teaching Hospital for serious illnesses such as diabetes, cancer, tuberculosis, etc.

During the discussion, most of the respondents said that in case of serious illness, they felt most comfortable giving their information to a doctor from their own ethnic background because they feel he will understand their plight better. This view was contrary to that of Haliya Maimuna and a few others who said that they don’t mind the tribe of the doctor.

Research Question Three
Do male and female patients perceive the relationship between a doctor’s ethnic background and interpersonal communication on serious illnesses the same way?
The group discussion sessions did reveal a difference in perception between male and female respondents regarding the influence of doctor’s ethnic background and interpersonal communication on serious illnesses. Most female respondents said that the ethnic background of a doctor influenced their willingness or otherwise to release more information on serious illnesses. Most female respondents feel freer to open up on serious illnesses to doctors of the same ethnic background.

Discussion of Findings

Research question one sought to find what language respondents communicated with the doctors during their visit to the hospital. The findings shows that majority of the respondents communicated in their various native languages more than in the English language. Once the respondents of Igbo language found out that a doctor was from their ethnic background, they switched to their native language as a medium of communication. These findings tally with Johnson and colleagues’ that “Racial and ethnic disparities among physicians and patients have made health practitioners use more of their lingua-franca.” [27] Saha and colleagues also noted that at the core of both patient centeredness and cultural competence is the ability of the healthcare provider to see the patient as a unique person; to build rapport with the best communication using language that can get messages across adequately. [26]

Research question two sought to find if the tribe of the doctor determines a patient’s level of releasing intimate information on a serious illness. From the above findings, a total of 62.3% said the doctor’s tribe is a determinant while 37.6% said it is not. This shows that a higher percentage agreed that the tribe determines the openness. The hypothesis tested in this work also revealed that the doctors’ ethnic background affects the level of information and level of communication patients have with them.

This agrees with what Miller and colleagues said, that a man from the south west knows what it takes to understand one from his vicinity. [36] It further agrees with the statement that the success of retention in treatment is attributed to better rapport and comfort between concordant patient-doctor dyads, resulting in greater patient satisfaction. [32]

This finding further supports the communication privacy management theory, which posits that the sharing of information occurs only when the individual has weighed the need to share information against the need to protect themselves. The disclosure of private information to a partner may result in greater intimacy, but it may also result in the discloser feeling more vulnerable. [22][23]

Research question three reveals that when a doctor is of a different ethnic background, this affects male and female patients’ relationship with the doctor. Gender was a factor in determining this fact. This finding did not support earlier findings which reveal that concordance by race (but not sex) contributes in varying degrees to a patient’s perceptions of a shared identity with their physician, a perception that appears to be an important part of the physician-patient relationship. [34] Responses from both the questionnaire distribution and focus group discussion sessions supported the finding that gender was a factor in determining whether a patient would disclose information on serious illnesses to a doctor based on the ethnic background of the doctor.

Conclusion

This study shows that there is a significant relationship between a doctor’s ethnicity and the patient’s relationship. Interpersonal communication between the doctors and respondents becomes more engaging when the doctor and patient are from the same ethnic group.

The majority of the patients sampled (62.3% of respondents who completed the questionnaire and 24 of those who participated in group discussion) said that the doctors’ ethnicity influences their communication level with the doctor and this shows that interpersonal communication between doctors and patients is more effective when the patient and doctor are from the same ethnic background.

This study demonstrates the need for doctors to improve on their interpersonal communication skills to instil confidence in patients and to enable such patients to feel free to discuss details of their illness with a doctor. The hospital may wish to consider ways to pair physicians and patients of similar ethnic backgrounds to foster greater communication.

References

  1. Ha JF, Longnecker N. Doctor-Patient Communication: A Review. The Ochsner Journal. 2010;10(1):38-43. Available at: www.ncbi.nim.nih.gov/pmc/articles/PMC3096184. Accessed September 27, 2015.
  2. Arora NK. Interacting with cancer patients: the significance of physicians’ communication behavior. Social Science & Medicine. 2003; 57(5): 791-806.
  3. Epstein RM & Street RL Jr. Patient-centered communication in cancer care: Promoting healing and reducing suffering. Bethesda, MD: National Cancer Institute; 2007.
  4. Nwankwo NN. Ethnicity and Doctor-Patient Communication: A Study of University of Abuja Teaching Hospital. [baccalaureate project work]. Igbariam, Nigeria: Anambra State University; 2015.
  5. Goold SD, Lipkin Jr. M. The doctor-patient relationship: challenges, opportunities, and strategies. J Gen Intern Med. 1999 Jan; 14(Suppl 1): S26–S33. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496871/#_ffn_sectitle. Accessed April 13, 2015.
  6. Lee SM. A review of language and other communication barriers in health care. Office of Minority Health (OMH), Office of Public Health and Science, US Department of Health and Human Services; 2003.
  7. Grant T. Problems of communicative competence in multi-cultural encounters in South African health services. Curationis 2006; 29: 54-60.
  8. Adegbite W, Odebunmi A. Discourse fact in doctor-patient interactions in English: An analysis of diagnosis in medical communication in Nigeria. Nordic Journal of African Studies. 2006; 15(4): 499-519.
  9. Thompson L, McCabe R. The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review. BMC Psychiatry. 2012; 12:87.
  10. Street RL Jr. (2003). Communication in medical encounters: an ecological perspective. In: Thompson TL, Dorsey AM, Miller KI, Parrott RR, eds. Handbook of Health Communication. Mahwah, New Jersey: Lawrence Erlbaum Associates; 2003.
  11. Cooper LA, Beach MC, Johnson RL, Inui TS. Delving below the surface. Understanding how race and ethnicity influence relationships in health care. J Gen Intern Med 2006;21 Suppl 1:S21-7. Review.
  12. Levy BS, Sidel VW. Social Injustice and Public Health, 2nd ed. New York: Oxford University Press, 2013.
  13. Martin LR, Summer LW, DiMatteo MR. The challenge of patient adherence. Ther Clin Risk Manag. 2005 Sep; 1(3): 189–199.
  14. Hamilton GA.. Measuring adherence in a hypertension clinical trial. Eur J Cardiovasc Nurs. 2003; 2:219–28.
  15. Farragher T. Doctors need to treat their patients with respect. Boston Globe. April 4, 2015. Available at: http://www.bostonglobe.com/metro/2015/04/03/doctors-need-treat-their-patients-with-respect/XUuE6oyXGz2dpyVNoRx6LJ/story.html. Accessed September 28, 2016.
  16. Gudykunst WB. An anxiety/uncertainty management (AUM) theory of effective communication: making the mesh of the net finer. In: Gudykunst WB, ed. Theorizing about Intercultural Communication. Thousand Oaks, California: Sage Publications; 2005.
  17. Gudykunst WB, Nishida T. Anxiety, uncertainty, and perceived effectiveness of communication across relationships and cultures. Int J Intercul Rel. 2001; 25: 55–72.
  18. Ormanova G. Uncertainty Reduction Theory; December 5, 2014. Available at: http://gormanova.weebly.com/reflections/uncertainty-reduction-theory. Accessed September 27, 2015.
  19. Griffin EM. A First Look at Communication Theory. New York: McGraw Hill; 2012.
  20. Brashers DE, Hsieh E, Neidig JL, Reynolds NR. Managing uncertainty about illness: Health care providers as credible authorities. In: Dailey RM, LePoire BA, eds. Applied Interpersonal Communication Matters: Family, health & community relations. New York: Peter Lang; 2006.
  21. Petronio S. Brief status report on communication privacy management theory. Journal of Family Communication. 2013; 13: 6–14.
  22. Petronio S, Durham W. Communication privacy management theory. In: Baxter L, Braithewaite D, eds. Engaging Theories in Interpersonal Communication: Multiple Perspectives. Thousand Oaks, California: Sage Publications; 2008.
  23. Waters S, Ackerman J. Exploring privacy management on Facebook: Motivations and perceived consequences of voluntary disclosure. Journal of Computer-Mediated Communication. 2011; 17: 101–115.
  24. Petronio S. Boundaries of Privacy Dialectics of Disclosure. Albany, New York: State University of New York Press; 2002.
  25. Beach MC, Saha S, Cooper LA. The role and relationship of cultural competence and patient-centeredness in health care quality. The Commonwealth Fund, October 2006. Available at: http://www.commonwealthfund.org/publications/fund-reports/2006/oct/the-role-and-relationship-of-cultural-competence-and-patient-centeredness-in-health-care-quality. Accessed September 24, 2015.
  26. Saha S, Beach MC, Cooper LA. Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc. 2008;100(11):1275–1285.
  27. Johnson RL, Saha S, Arbelaez JJ, et al. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19:101–110.
  28. Brach C, Fraser I. Reducing disparities through culturally competent healthcare: An analysis of the business case. Qual Manag Health Care. 2002; 10(4):15-28.
  29. Stone, J. Race and healthcare disparities: overcoming vulnerability. Theor Med Bioeth (2002) 23: 499.
  30. Alegría M, Roter DL, Valentine A, et al. Patient-clinician ethnic concordance and communication in mental health intake visits. Patient Educ Couns. 2013; 93(2): 188–196.
  31. Collins K, Hughes D, Doty M, et al. Diverse communities, common concerns: assessing health care quality for minority Americans. The Commonwealth Fund 2001 Health Care Quality Survey. New York: The Commonwealth Fund; 2002.
  32. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003 Dec 2;139(11):907-15.
  33. Odebunmi A. Greetings and politeness in doctor-client encounters in South-Western Nigeria. Iranian Journal of Society, Culture & Language. 2013; 1(1): 101-117. REFERENCE
  34. Street RL, O’Malley KJ, Cooper LA, Haidet P. Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity. Ann Fam Med. 2008 May 1; 6:3, 198-205.
  35. Wimmer RD, Dominick JR. Mass Media Research: An Introduction, 9th ed. Boston: Wadsworth; 2011.
  36. Miller AN, Booker NA, Mwithia JK, Kizito MN Ngula K. Kenyan patients’ attitudes regarding doctor ethnicity and patient-provider communication. African Communication Research. 2011; 2: 267-280.

Copyright: © 2016 Chinenye Nwabueze and Nancy N. Nwankwo. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the authors, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.

Donate