Do minority patients feel that working with co-ethnic healthcare professionals makes clinical interactions more patient-centered? Through in-depth interviews with 60 low-income LEP (limited English proficiency) Vietnamese and Mexican immigrants, this study by Research Affiliate Ming-Cheng Lo inductively documents an alternative model of therapeutic alliance.
While the dominant model of patient participation and therapeutic alliance focuses on in-depth doctor-patient negotiation at the individual level, the multiply marginalized patients in our study pursued these goals mainly by building a partnership with the institution of medicine, actively navigating around what they perceived to be “ghettoized” care while searching for “good” science within the system. Patients preferred a model of modern medicine characterized by heavy-handed intervention and medicalization, which often differed from the medical model they encountered in the US. This difference in perspective was further complicated by these patients’ structural marginalization. In this alternative model of therapeutic alliance, ethnic concordance, net of linguistic concordance, negatively impacted clinical interactions through intra-ethnic boundary-work. These findings challenge the prevalent assumption that ethnic bonds and shared cultures necessarily render concordant clinical relationships patient-centered. At a theoretical level, this study challenges the lifeworld-medicine dichotomy, instead underscoring the plurality of the voices of medicine as well as the power dynamics within the lifeworld.