‘‘Us versus Them’’ 269
had a style similar to hers in terms of being ‘‘warm and fuzzy’’ with
patients.
At job interviews, I was very much impressed with the vibes I got.
At one interview, I didn’t get a good vibe, so I chose another job.
I wanted to work with a female colleague I knew and respected; we
have very similar practice styles because we trained together.
Jessica’s group practice inculcated new members into its approach,
suggesting how doctors may choose practice settings through pro-
cesses of mutual selection. ‘‘We trained a resident in our clinic for four
years, so we indoctrinated her in our style. And she found it attractive,
because she wanted to come work with us. She selected us and we selected
her.’’
Styles can also evolve to fit the characteristics of patient populations.
Jessica added:
Most of the staff and patients are Latino. Latinos are very warm,
demonstrative and friendly. People bring food, and respect me for
being warm and fuzzy. My approach enhances my stature with
patients.
Others tried to balance with each individual patient the benefits of a
hierarchy versus the desire for equalization. Hence, physicians may adjust
their styles to meet the needs and challenges of particular patients. Over
time, physicians dynamically equilibrated of their closeness with patients.
These styles resulted from inherent character traits, and implicit rather
than explicit teaching.
Gradients of Shared Decision-making
Physicians reassessed and often altered not only the boundaries of their
relationships with patients, but also their specific approaches to decision-
making, adopting a spectrum of models from traditional ‘‘doctor knows
best’’ to more equal ‘‘sharing.’’ Doctors modified traditional stances in
various ways—from patients essentially making decisions alone, without
strong physician input, to engaging in mutual processes of negotiation.
Many patients wanted not to share decision-making completely, but
to re-equilibrate the relationship, and have the physician simply explain
decisions better. Harry, for example, said: