Western Galilee Academic College, The Max Stern Yezreel Valley College, Israel.
Soc Sci Med. 2019 Aug;235:112358. doi: 10.1016/j.socscimed.2019.112358. Epub 2019 Jun 7.
Current literature on patient-physician concordance emphasizes its advantages. Racial, ethnic, cultural and linguistic concordance was found to impact patient-physician communication positively and to lead to improved healthcare quality and outcomes. Patients' preference for ethnic discordance, on the other hand, appears anomalous and has barely been studied. The present research sought to evaluate the rates of patients from the Jewish majority and the Arab minority populations in Israel who prefer patient-physician ethnic discordance, and to examine the reasons for this preference. A mixed method methodology was employed: a survey (n = 760; 505 Jews, 255 Arabs), as well an exploratory qualitative study based on in-depth interviews with 38 Jewish and Arab patients in Israel. The survey's findings indicate that Arabs are more likely to prefer to be treated by a Jewish physician than are Jews to prefer an Arab physician (family physician - 4.3% vs. 0.4%, p < .0001; surgeon - 5.9% vs. 0.8%, p < .0001). The difference is age-dependent: young Arabs are more likely than older ones to prefer a Jewish physician. The reasons for Arabs' preference for a Jewish physician are fear of a breach of confidentiality, and internalized racism. The reasons for Jews' preference for an Arab physician are the disposition and professionalism attributed to the latter, which are perceived to stem from their need, as a minority population, to excel and to prove themselves. Despite the emphasis placed in scholarship and clinical practice on the importance of cultural and linguistic competency in healthcare, a preference for ethnic discordance should also be taken into account, especially regarding patients from minority collectivist populations.
目前有关医患一致性的文献强调了其优势。研究发现，种族、民族、文化和语言的一致性会对医患沟通产生积极影响，并提高医疗质量和效果。另一方面，患者对族裔不和谐的偏好似乎反常，几乎没有得到研究。本研究旨在评估以色列犹太多数族裔和阿拉伯少数族裔患者中偏好医患族裔不和谐的比例，并探讨这种偏好的原因。本研究采用混合方法：一项调查（n=760；505 名犹太人，255 名阿拉伯人），以及一项基于对 38 名以色列犹太人和阿拉伯患者深入访谈的探索性定性研究。调查结果表明，与犹太人相比，阿拉伯人更倾向于选择犹太医生治疗（家庭医生 - 4.3%比 0.4%，p<0.0001；外科医生 - 5.9%比 0.8%，p<0.0001）。这种差异与年龄有关：年轻的阿拉伯人比年长的阿拉伯人更倾向于选择犹太医生。阿拉伯人偏好犹太医生的原因是担心泄露机密，以及内化的种族主义。犹太人偏好阿拉伯医生的原因是后者的态度和专业性，这些特质被认为源于他们作为少数民族群体需要出类拔萃并证明自己。尽管学术和临床实践都强调医疗保健中文化和语言能力的重要性，但也应该考虑到族裔不和谐的偏好，尤其是针对少数群体患者。
