Intraethnic characteristics and the patient-physician interaction: "cultural blind spot syndrome".

Ethnic variation in the beliefs, expectations, and illness behavior of patients has dominated cultural studies of medical care. A widespread supposition, referred to as "cultural blind spot syndrome," assumes that similarities in the ethnic backgrounds of patient and physician invariably enhance clinical communication, thereby resulting in improved outcomes. The author's experience as a Western-trained Chinese physician attending to a wide spectrum of Chinese patients challenged this simplistic assumption. The cultural identity of the Western-trained physician and intraethnic variation among people of a common cultural heritage emerged as two key considerations from this analysis of patient-physician interaction. Two cases representing extremes in patient-physician interaction were chosen and analyzed with respect to each of six essential elements of patient-physician interaction. Common ethnicity does not ensure a positive patient-physician interaction. A good match among intraethnic descriptors of patient and physician enhances communication and thereby may improve outcome. However, the match between the patient's explanatory model and expectations of the physician and the physician's actual persona and practice is equally important in determining outcome.