The doctor-patient relationship in an ethnically heterogeneous society

This paper concerns aspects of the physician's role performance which are associated with two latent functions of the medical institution for its client: provision of status and provision for catharsis. The institutional context of the study is Kupat Holim, the Workers' Health Insurance Institution of Israel which provides preventive, diagnostic and curative treatment for approximately three-quarters of the Jewish population of Israel. Clinics are usually located in local communities or neighborhoods and access to the physician is free to members during clinic hours. 342 Kupat Holim physicians with experience treating Rumanian and Moroccan patients in rural and urban settings completed a systematic questionnaire and the present material is drawn from the analysis of these data. The findings suggest that these two latent functions of the Kupat Holim clinic are differentially 'activated' by physicians for different types of clients. Physicians tend to 'give' more status to Rumanian than to Moroccan clients possibly because of the latter's tendency to conform less to the prescribed role of Western patients or because of physicians' own internalization of prejudice norms which are prevalent in the larger social system. At the same time it is of interest to note that physicians do not differentiate between ethnic groups of clients in their readiness to 'provide' for catharsis. There is therefore no evidence to support the contention that cultural closeness increases the physician's willingness to 'provide' for catharsis. There is no evidence for more particularistic doctor-patient relationships in rural as compared to urban clinics. The findings suggest a revision of our originally proposed hypothesis to the effect that physicians in urban practices will be under greater professional, colleagual scrutiny and will therefore be more likely than their rural counterparts to conform to norms of the profession.