Myah Caruso, Psy.D., is a 2017 graduate of the Psy.D. Program in Clinical Psychology at Antioch University, New England

Dissertation Committee:

  • F. Alexander Blount, EdD, Committee Chair
  • James Fauth, PhD, Committee Member
  • Cynthia Whitaker, PsyD, Committee Member


physician-patient communication, physician-patient relationship, socioeconomic status, rural primary care, power asymmetry in the physician-patient relationship, qualitative research

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This qualitative study utilized interpretive phenomenological analysis (IPA) to explore the patient-physician relational experience from the perspective of patients of lower socioeconomic status (SES). Research shows that physicians engage in collaborative care less frequently with patients of lower SES than with their more advantaged counterparts and that lower SES patients participate less during office visits. Information on the patient-physician relational mechanisms that inhibit collaborative care from the perspective of low SES patients is a key gap in this literature. Five adult patients from the lower socioeconomic strata, who were established patients of a primary care physician were recruited from a primary care practice in a rural area and interviewed. Data analysis identified six superordinate themes that best capture how patients experience the relational dynamics of the patient-physician relationship. The results show that physician-patient power asymmetry can be experienced by patients of lower SES as reminiscent of further examples of previous experiences of stigma and oppression. Future visits or aspects of a treatment plan may be avoided following an unpleasant medical encounter or a weakened patient-physician alliance. The emotional reactions of patients contribute to their loss of voice, and some disclosures are viewed as too risky to share with treating physicians. These interviews also showed that personable physicians increase patient comfort and physicians who proactively seek out and address patient dissatisfaction mend ruptures and strengthen the patient-physician relationship. The study describes the mechanisms by which patients of lower SES are susceptible to experiences of stigma and psychological oppression during medical encounters. It offers implications for practice and possible pathways for future research to minimize experiences that are barriers for patients and to maximize the great potential of the patient-physician relationship as a factor in improving the health of a very vulnerable population.


Myah Caruso

ORCID Scholar ID# 0000-0002-3806-083X