Table 2.

Themes that Emerged from Qualitative Analysis of Interviews and Observations on the Subject of Social and Professional Identities, From a Study of 25 Academic Physicians’ Performance of Professional Identity, University of Utah School of Medicine, 2015–2016

Theme	Quotation
Theme 1: Physicians described social identities differently
Women	[Gender] is a big one … it definitely is a big deal to be a woman.
	My gender is probably my primary [identity]; I identify as female.
	I guess I identify kind of on my gender more than anything else.
	[with regards to how patients call her by her first name] I think patients, as well as staff, sometimes [do it] too “I’m like you wouldn’t do that to Dr. Smith, for example.” Like my boss who’s a man—you would not come into his office and say “Hey, John…” You just wouldn’t.
	I think [gender] does make a difference, and I definitely purposely wear [my white coat] most of the time, but even with that I still get you know I can be wearing my white coat and my stethoscope and ID badge and dressed professionally and still have people say we haven’t seen the doctor all day.
	It definitely is a big deal to be a woman…. Even in the field of pediatrics which is the majority female, I still most often when encountering someone who doesn’t know what I do, but who sees me in scrubs or hears that I have worked overnight in the hospital, the most common response is, “Oh are you a nurse?”
Men	I don’t notice [gender] very much frankly.
	[I am] male, sort of standard male identity.
Racially/ethnically minoritized participants	I think probably for me one of the things I identify most is being a person from South America.
	I think still being Asian American is my dominant identity.
	I think I have a strong connection to Peru as part of my heritage.
	So when they come in … sometime I see a blank stare because I’m sure they were looking for an older white male which didn’t happen, and I am not sure they have ever seen a person from [my country], or so.
	When you grow up being an ultra minority. It’s nothing you are mad about, you are just different, and everyone knows it. You get comments all the time that remind you of your otherness.
	As a woman and a minority, it has its own special set of challenges. You know, your classmates doubting whether you actually really belong, that you didn’t take the spot of a more qualified White male. You know, I had harassment emails when I was in medical school and the Dean’s Office didn’t do anything.
Racially/ethnically non-minoritized participants	I’m very White [laughter].
	I’m a … Waspy guy from a pretty Waspy background.
	It wasn’t until I was 14 that I knew that I was actually White. And that being Greek-American was more of a cultural thing.
	My family is very open and very accepting and so I never felt like there was any sort of bias. But you sometimes don’t realize what biases you have until you’re actually in situations with more diverse people.
	I don’t think it was like this totally idealistic like there were no racial issues, [but] … I had never really thought through how one negotiates those different kinds of disparities because it was like never part of my reality in a lot of ways.
Theme 2: Physicians described professional practices differently
Building relationships
Professional learning	[I learned to be a physician from] seeing my dad’s doctors … shadowing, and then observing it in medical school about what it meant to be a physician.
	There is that traditional boundary thing, but if you bond with someone, that is a natural thing to give someone a hug or if they are crying or if they feel blue, to also comfort them physically and not just give them tissue, so [my mentor] was very much like that.
Personal learning	I think being able to speak Spanish that’s really helpful to a lot of my Spanish speaking patients especially a lot of them are brand new to the U.S. and they get diagnosed with [a disease],… so I think it’s a comforting thing that I can at least communicate with them.
	I think I’m easily relatable because I think I’ve interests in few places. I like to go fishing, or I like to try to find an interest of theirs, and at least provide some confidence in whether it’s like fishing or being outside. A lot of people like doing things outside around here—cooking, or children, or what have you. Just to kind of humanize the appointment. I think that’s one of my strengths.
Personalized care
Professional learning	I think there needs to be an understanding really between what the patient is expecting and what they want out of their care and what they want out of their treatment, which is going to differ across the spectrum from old to young to cultural upbringings to what expectations doctors can provide to race, ethnicity—whatever … those expectations need to be taken into consideration.
	I think what you realize is that the same approach doesn’t work for each patient. And so having open-ended questions works for most patients…. There are patients who really want you to direct their care, and then there are many patients that don’t.
Personal learning	Between college and medical school I was an EMT for a year, driving an ambulance. So everybody calls the ambulance, right?… So THAT was really eye-opening, because you’re in people’s houses, right? And you’re seeing what people live like. That was a real eye-opening experience. I think it was kind of a shock…. It made you realize what a lot of people live like … if you don’t understand how people live, it’s hard to understand why they don’t do the things that doctors ask them to do. Like take their medications. Because maybe their home life is really hectic or they can’t afford their medication, even if they’re really cheap. Or why they no-show to their appointments because they can’t afford a car and they can’t make it to their appointments. And busses break down, so it gives you a better reference for understanding the patients and the things that make it hard for them to do what they’re trying to do.
Conveying information
Professional learning	Everyone has a different level of understanding and ability with medical jargon or medical information in general and kind of being a steward for that by providing them as much as information that’s fact-based and not based on my personal opinions unless they ask me.
	Here’s a pattern we default to, where interacting with patients we want to give them as much information as possible. Most of the time it’s too much … so if there are four things I want to communicate with my patient, I start with two. And we go through that and then I try to assess their understanding. And if they get it, and they can communicate it back to me, and we have time then we’ll move on to the next to. And if not, then I say, OK, this is a good place to stop…. So let’s do these things and then come back and visit these other issues in a month.
Personal learning	I think that I have a better appreciation [having taught high school] for meeting people where they are as far as talking to patients. Because I think that there’s a gap between providers and patients and in regards to health literacy, which makes sense because you go to school and you [talk like] this big fancy person. But then you have to tell a real person what is going on and make that real to them, and make them understand it.
Theme 3: Comparisons of described practices with patient interactions
Observable matches	Description of practice from interview: Well I do think I am a little bit … I do take more time I think in explaining—this is what you’ve got; this is what it means. I think I spend quite a bit more time educating.
	Observed patient interaction: Yeah, so what you can see, and there’s just a little bit of a different technique here, but what you had then is—and this is actually a really, really important concept because a lot of times, we’ll get into a big fuss over is this better or is this worse. So she had all these spots of cancer that look much more dense now, and why do we think that is? [patient responds] because healing bone gets dense, yeah. So this is the normal bone, and there’s the cancer. So you would say, “Well, if cancer is this whiter color, then this looks like more cancer,” but really, we think it’s just healing.
	Description of practice from interview: My wife is Hispanic … they only speak Spanish and so I speak a little bit of Spanish. And so even though I’m not Hispanic—I can empathize with everything that they’ve gone through through my wife and through her family. So I think my interactions with minority populations here in Utah gives them a different perspective on how to talk to people that come from different backgrounds.
	Observed patient interaction: [after patient’s partner asks if it is okay to travel to Mexico to see family before the procedure]…I think if you wanted to go to Mexico [pronounced in Spanish], you should probably go in the next month or so if possible.… I think you’re safe to go, but I think after one month we probably want to start [the procedure]…
	Description of practice from interview: But [spending time with patients is ] important to me—and that will ALWAYS be more important to me than being on time in clinic or making sure I see 30 patients a day. And with the pressures of seeing more patients and billing more—I don’t care. I’d rather spend the time, to be totally honest, and waste money.
	Observed patient interaction: OK, Just to let you know—I know you’re frustrated and this is not an easy thing to fix and make better. But I’m willing to work at it with you and I’m not going to dump you just because we can’t figure out the first reasonable cause, OK? This is not a silver bullet, as you can tell. There’s lots of different things, and you have to be willing to try and try different things, and you have to have a physician willing to work through it all with you. So you and I are going to become good friends.
Unobservable matches	Description of practice from interview: I think when I’ve had an African American patient come to one of my clinics, I think they’re happily surprised that I am. [It doesn’t happen often.] I think I’ve had like three, but it’s been really cool. Like one of them, in talking to her, I found out like we’re in the same sorority and so we talked about that. That was just a really enjoyable patient encounter for me. So I think when I see African Americans in my clinic I get really jazzed, and I think they get jazzed to see me.
	Description of practice from interview: Asking what works best for them and taking a wholesome picture because yeah I can prescribe this medication. This might be the recommendation, but the patient says I cannot afford it. Then again you have to troubleshoot that side of it, so again you see what works best for the patient. I mean the basic concept is same in any country but just how you approach it maybe. We didn’t have to worry about insurance or other things when we were growing up [in my country].
	Description of practice from interview: Yeah, I noticed this when I was in [location where I trained] [where] I had a lot of African American patients. That was the nice thing about African American patients look of various—very light skinned to very dark skinned to totally different, and so most of my patients just assumed I was black just like them. They could joke with me about certain things, or they’d be like, “Oh I’m glad I don’t have a white doctor.” They would seriously say that to me, so I was like, “Wow, hmm well that’s fine.”
	Description of practice from interview: [Speaking Spanish] helps a lot, especially for these complex problems, yeah. If there are Hispanics here, it definitely helps. So I try to see them [as often as] I can.