When rapport building extends beyond affiliation: communication overaccommodation toward patients with disabilities

Area of Science:

• Medical Education
• Communication Studies
• Disability Studies

Background:

• Physician-patient rapport is crucial for relationship-centered care.
• Rapport-building communication may inadvertently become patronizing towards patients with disabilities.
• This study examines communication behaviors that cross boundaries with disabled patients.

Purpose of the Study:

• To identify and analyze communication behaviors that exceed expected rapport boundaries with patients with disabilities.
• To provide context for interpreting when rapport-building becomes patronizing.

Main Methods:

• Qualitative analysis of videotaped interactions.
• 142 third- and fourth-year medical students and standardized patient educators with physical disabilities participated.

Main Results:

• Six themes of exceeding rapport boundaries were identified: baby talk, kinesic movement, vocalics, relationship assumptions, emotional divergence, and inconsistency with patient cues.
• Behaviors like exaggerated gestures, stiff posture, inappropriate volume, assumptions of care-receiving, minimizing disability, and mismatched emotional responses were observed.
• These behaviors, while sometimes intended as rapport-building, can be perceived negatively.

Conclusions:

• Positive communication behaviors can have negative implications if excessive, inconsistent with patient disclosure, or incongruent between verbal and nonverbal cues.
• The identified themes highlight how rapport-building can be misinterpreted as patronizing behavior towards patients with disabilities.
• Interpreting communication within patient disclosure context and recognizing biases are essential for effective communication.