Through the Lens of Dance Medicine: Shared Identity in Patient-Provider Relationships

Faye Shemper

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Does a diabetes educator need to be a person with diabetes to provide quality services to a patient? Does a dance medicine specialist need to spend their weekends in the studio, or a sports medicine physician be an ex-D1 athlete? Would you trust a provider who has never been a patient in their own medical specialty?

While it is unrealistic to require providers to personally identify with their patient pool, we must acknowledge the unmistakable benefits and substantial history of shared identity in the healthcare encounter. Concordance and shared identity have become increasingly researched dimensions of the patient-provider dynamic, specifically in relation to quality of care, patient satisfaction, and levels of medical mistrust. Concordance in a medical setting is broadly defined as a similarity between physician and patient. Be it race, gender, sexual orientation, age, religion, ethnicity, socioeconomic status, or parental status, we most often understand concordance in the sense of shared demographic attributes. At its core, though, concordance simply translates to harmony, consistency, and agreement between multiple parties.

In the medical context, shared occupational interests, medical or mental-health history, and values, beliefs, and communication styles can have as much of an impact on a patient’s experience as can demographic concordance. Though not all medical specialties benefit from occupational concordance, there are several whose histories are very tightly interwoven with a provider’s intimate knowledge of a patient’s lifestyle and, consequently, their ability to treat their patient holistically and empathically. Chief among such disciplines is dance medicine, an emerging subdivision of sports medicine that addresses the unique health and performance needs of dancers.

We can imagine that when patients see a doctor similar to themselves (particularly in physical or social presentation), they may be more inclined to trust their judgment, perceive less social distance and threat, and assume shared values.^[1] Of course, the patient experience is only half of the equation; physicians themselves must work to earn their patients’ trust. And though researchers have focused on eliminating implicit biases and defending the benefits of demographic similarities, they have neglected other critical aspects of identity, like occupational factors, that providers can access to improve the quality of care they offer.^[2]

When thinking about providers in niche specialties who are responsible for the health of populations with unique health conditions, lifestyles, and pain tolerance scales, the extent to which a provider personally shares in the experiences and beliefs of their patients can have dramatic effects on the way they treat them. Take dance medicine, which first caught momentum in the 1970s when Dr. William Hamilton became one of the nation’s first orthopedic company physicians. Hamilton first worked with the New York City Ballet and then with other prominent organizations like the American Ballet Theater, the New York Knicks and Yankees, and NYU’s Harkness Center for Dance Injury.^[3] Like many of his dance medicine contemporaries, he had little foundational knowledge of or personal experience with dance as an art form, providing screenings and care during company rehearsals through an orthopedic sports medicine lens.

Realizing his audience required a very particular approach to treatment, Hamilton spent most weekends during his first five years at the New York City Ballet observing George Balanchine’s ballet classes at Lincoln Center.^[4] There, he studied professional dancers in the midst of their training and learned ballet terminology in hopes of better visualizing pathways toward dance injury. By extension, he also hoped to narrow the gap between him and his patients. Still, Hamilton was not himself a dancer and was new to the psychology and circumstances of his patient population; consequently, it was not uncommon for him to report difficulty understanding dancers’ pain tolerance and properly supporting these artists’ lifestyles.^[5]

Despite having more information at their disposal than ever before, today’s dance medicine specialists–and consequently, their patients–face similar obstacles. Through my thesis work around dance injury, I discovered Dr. Foram Patel, a dance medicine specialist and physical therapist based in New York City and Jersey City. In addition to running a dual-location business, E-Motion Physical Therapy and Wellness, that skillfully serves both recreational and professional dancers, Patel has dedicated much of her own time to studying dance in order to better connect with her patients. Similar to Hamilton, she felt that the only way to rehabilitate dancers effectively was to adopt a part of their lifestyle and “learn to speak their language.”^[6] But unlike Hamilton, Patel decided early in her career that it would not be enough to observe dancers. In order to tackle the root of dance injury, rather than just perceptible symptoms, she understood that she had to share in the occupational identity of her clients. Today, approximately seven years into her dance journey, Patel still trains at a reputable dance academy, cross-trains in areas such as Olympic weightlifting, and has transformed her therapy space into what she likes to call, and what is undeniably, a “Temple for Dancers.”^[7]

Dr. Patel’s deliberate interaction with dancers outside of clinical spaces informs not only her treatment methods, but likewise the logistics surrounding her business. As a dancer herself, she is able to account for her patient population’s unique financial circumstances and balance that with dancers’ need for thorough and unrushed treatment sessions. Although she sees a variety of patients, there is a discounted rate specifically for dancers, and the timing of payment is very flexible to counteract the financial burdens that often scare dancers away from medical care in the first place.

Finally, Patel’s attention to detail demonstrates how occupational concordance can entirely transform the patient-provider relationship. For instance, while a provider without dance experience may perform cupping therapy on a patient without thinking twice, Dr. Patel and her colleague Dr. Coar may remember that their patient has a performance later that evening and ask whether they want the procedure administered, given it may leave bruises. As dancers themselves, they know to ask questions like: “Is your costume open-back?” “Where can I position the cups so that the marks they leave are obscured during your performance?” “How easily do you bruise?” “Should I increase blood flow using a different system today?”^[8] They regularly ask patients to share a video from their most recent show, or inquire about dance class plans for the week and allow that to guide their choice of treatment.

Patel’s commitment to developing a shared occupational identity with her target patient population has not only increased the quality of care she provides but also has ensured consistent patient trust in her work, adherence to treatment, overall satisfaction with care, and likelihood to recommend her services to other dancers. The patient testimonials on her business’s Instagram page, @e.motionpt, speak for themselves. Patients describe E-Motion as more than a place of healing. They call the center a “happy place” and stress the “integral” role Patel plays in their wellness journey beyond dance injury.^[9]

Though Patel and dance medicine are just one example of the potential of occupational concordance, they show how shared identity improves patients’ satisfaction with and trust in medical providers, as well as providers’ delivery of quality care. Still, occupational concordance is not always possible and has yet to score the academic attention it deserves. Instead, research has focused far more on patients actively seeking providers with cultural, racial, and other demographic identities similar to their own.^[10] This is in part because demographic concordance is more measurable and less ambiguous than occupational concordance. If one wanted to measure demographic concordance, for instance, they could explore patient satisfaction or treatment adherence with respect to concrete subject variables like race, ethnicity, or gender. But studying occupational concordance is more abstract– to what extent, in what environments (e.g. studios, companies, stages), and for how long must a provider study dance on their own time to even establish “occupational concordance” with their patient?

As a result, concordance studies in lab and clinical settings emerged fairly recently and are limited to concordance in social identity. American professor of medicine Neil R. Powe, with his colleague Lisa A. Cooper, spearheaded efforts in this subject area. In July 2004, they published one of the field’s first and most widely revisited studies, which emphasizes how racial discordance, inadequate cultural competency training, and lack of workforce diversity have contributed to disparities in patient care.^[11] At the very least, this study reinforces the notion that increasing physician diversity creates more opportunities for minority patients to feel understood by and satisfied with their providers. More broadly, Powe and Cooper set the momentum for concordance studies and launched much-heated debate about how exactly race, gender, and other demographic factors affect patients’ experiences. Some studies suggest that when a physician and patient share the same race or ethnicity, it can lead to increased patient trust, greater utilization of services, and improved decision-making. Others, meanwhile, find no significant effects between racial concordance and the patient experience, and even less so in categories such as age and gender identity.^[12]

While we have yet to confidently make claims about the value of demographic concordance between patient and provider, or to conduct research on occupational concordance more specifically, we see the effects of shared identity play out in our own and our loved ones’ healthcare experiences in real time. Medicine and medical mistrust, mistreatment, and vulnerability have always gone hand in hand, and at the crux of it all is the inherent patient desire to feel understood. The heartfelt testimonials and promising recoveries that result from Dr. Patel’s work support the potential of occupational concordance to fulfill this desire, though it is difficult to know why without further investigation. As we strive to improve ever-shifting patient-provider dynamics, exploring concordance could make a major difference in the delivery of quality care and patient satisfaction across medical institutions.

Notes

1. Richard L. Street et al., “Understanding Concordance in Patient-Physician Relationships: Personal and Ethnic Dimensions of Shared Identity,” The Annals of Family Medicine 6, no. 3 (May 2008): 198–205, https://doi.org/10.1370/afm.821. ↑
2. Lisa A. Cooper and Neil R. Powe, “Disparities in Patient Experiences, Health Care Processes, and Outcomes: The Role of Patient-Provider Racial, Ethnic, and Language Concordance”(July 2004), https://doi.org/10.13016/xfcu-rh1z. ↑
3. Jennifer Stahl, “Remembering Dr. William Hamilton, Dance Medicine Pioneer,” Dance Magazine, April 13, 2022, https://www.dancemagazine.com/dr-william-hamilton/#gsc.tab=0 ↑
4. William Hamilton, “William Hamilton, MD PED Talk – Foot and Ankle Injuries in Ballet Dancers,” filmed 2022, AOFAS video, 18:08 to 18:43, https://www.youtube.com/watch?v=5hHXwjvKfL8 ↑
5. William Hamilton, “William Hamilton, MD PED Talk – Foot and Ankle Injuries in Ballet Dancers,” filmed 2022, AOFAS video, https://www.youtube.com/watch?v=5hHXwjvKfL8 ↑
6. Foram Patel, discussion over video call, February 25, 2024. ↑
7. Foram Patel, discussion over video call, February 25, 2024. ↑
8. Foram Patel, in-person communication, April 11, 2024. ↑
9. E-Motion Physical Therapy (@e.motionpt), “We are grateful to have been working with this client consistently, helping support her health and longevity,” Instagram video, July 30, 2024, https://www.instagram.com/p/C-DRZwgAYzq/. ↑
10. Richard L. Street et al., “Understanding Concordance in Patient-Physician Relationships: Personal and Ethnic Dimensions of Shared Identity,” The Annals of Family Medicine 6, no. 3 (May 2008): 198–205, https://doi.org/10.1370/afm.821. ↑
11. Lisa A. Cooper and Neil R. Powe, “Disparities in Patient Experiences, Health Care Processes, and Outcomes: The Role of Patient-Provider Racial, Ethnic, and Language Concordance”(July 2004), https://doi.org/10.13016/xfcu-rh1z. ↑
12. Richard L. Street et al., “Understanding Concordance in Patient-Physician Relationships: Personal and Ethnic Dimensions of Shared Identity,” The Annals of Family Medicine 6, no. 3 (May 2008): 198–205, https://doi.org/10.1370/afm.821 ↑

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Featured image caption: Photo by Jonathan Borba.