A core element of the patient-physician relationship is respect, which has been defined as “the recognition of the unconditional value of patients as persons” [1
]. Beach et al showed that physician respect varies across patients [2
]. The same study found that physicians exhibited different communication behaviors during encounters with patients whom they respected, such as sharing more information and having a more positive emotional affect [2
]. Although the philosophical ideal of respect should be independent of a patient’s personal characteristics, studies have shown that increased patient body mass index (BMI) is negatively associated with physician respect [3
] and multiple studies document health professionals’ overall negative regard towards patients with obesity [4
Despite negative provider attitudes, other studies find that obese patients are satisfied with their healthcare providers [10
]. These paradoxical findings may result from patients’ inability to accurately perceive providers’ negative regard. Societal discrimination towards obese persons is common in work, educational and social settings [14
]. Therefore, we theorize that obesity may alter a person’s ability to accurately perceive the attitudes of others during interpersonal interactions, either through desensitization or over-sensitization to disrespectful behaviors. For example, if an obese patient is desensitized to disrespectful behaviors, then he/she may interpret biased treatment from their physician as normal, and consequently overestimate physician respect. Conversely, a patient who has heightened awareness of any disrespectful attitude may underestimate physician respect. This idea of inaccurate estimation of physician attitudes among obese patients is supported by work from Brandsma [16
]. In Brandsma’s study, dyads of physicians and their obese patients were recruited to participate in a survey about general attitudes regarding obesity. When physicians’ attitudes were compared to how their patients perceived the physicians’ views, the patients perceived less positive attitudes than those reported by physician. This survey asked questions regarding attitudes towards obese individuals in general, and did not ask about physician attitudes toward the patient surveyed. To date, no studies have compared patient and physician perspectives to evaluate how obesity impacts the patient’s ability to accurately estimate his/her physician’s level of respect.
Obese patients’ ability to accurately estimate their physicians’ attitudes may have implications regarding the authenticity of these patient-physician relationships. Beach and Inui conceptualized authenticity as the physician not only acting respectfully towards a patient, but also actually having respect for that patient [17
]. Arnason described an authentic conversation as when patient and physician participate in a dialogue in which the subjectivity of both is respected [18
]. While the association between authenticity and patient outcomes has yet to be evaluated, authenticity is considered an ethical principle in patient-physician relationships [17
]. Authentic conversations may facilitate shared decision-making and reduce alienation between patients and physicians [18
]. If obese patients are not able to accurately estimate their physicians’ regard, then the authenticity of these patient-physician relationships may be compromised.
In this study, we aimed to justify our theory that obesity alters one’s ability to accurately perceive the attitudes of others during interpersonal interactions by examining whether patients’ weight influences their ability to accurately estimate levels of physician respect. We hypothesized that higher patient BMI would be associated with both overestimation and underestimation of physician respect. In addition, we assessed the level of physician respect as rated by an independent third party, in order to assess differences in physician respectfulness that may have contributed to over- or underestimation of respect.