Patient or Physician Centered Care?: Structural Implications for Clinical Interactions and the Overlooked Patient

摘要

Patient-centered care is widely supported by physicians, but this wide-spread support potentially obscures the social patterning of clinical interactions. We know that patients often want religious/spiritual conversations in the context of medical care but the provision is infrequent. As there is regional variance in religiosity, a gap in the literature exists regarding whether patient populations’ religiosity is connected to physicians’ self-reported religious/spiritual interactions. Using a national sample of U.S. physicians linked to county-level measures, the author test whether both physicians’ background and patient population characteristics are related to religious/spiritual interactions. Specifically, do physicians in more religious locations report more frequent religious interactions and is this dependent on whether the physician is also religious? Or does the religiosity of patient populations fail to explain variance in the frequency of inclusion? Logistic regressions with spatial lag terms highlight the importance of physicians’ background for inclusion of religiosity/spirituality. County-level variance of religious concentration is largely unrelated to the inclusion of religiosity/spirituality. The provision of patient-centered care is complicated. The inclusion of something patient-specific, such as religious/spiritual content, may not depend on the characteristics of the patient population, but those of the physician they see.