Race, gender, and partnership in the patient-physician relationship.

CONTEXT Many studies have documented race and gender differences in health care received by patients. However, few studies have related differences in the quality of interpersonal care to patient and physician race and gender. OBJECTIVE To describe how the race/ethnicity and gender of patients and physicians are associated with physicians' participatory decision-making (PDM) styles. DESIGN, SETTING, AND PARTICIPANTS Telephone survey conducted between November 1996 and June 1998 of 1816 adults aged 18 to 65 years (mean age, 41 years) who had recently attended 1 of 32 primary care practices associated with a large mixed-model managed care organization in an urban setting. Sixty-six percent of patients surveyed were female, 43% were white, and 45% were African American. The physician sample (n = 64) was 63% male, with 56% white, and 25% African American. MAIN OUTCOME MEASURE Patients' ratings of their physicians' PDM style on a 100-point scale. RESULTS African American patients rated their visits as significantly less participatory than whites in models adjusting for patient age, gender, education, marital status, health status, and length of the patient-physician relationship (mean [SE] PDM score, 58.0 [1.2] vs 60.6 [3.3]; P = .03). Ratings of minority and white physicians did not differ with respect to PDM style (adjusted mean [SE] PDM score for African Americans, 59.2 [1.7] vs whites, 61.7 [3.1]; P = .13). Patients in race-concordant relationships with their physicians rated their visits as significantly more participatory than patients in race-discordant relationships (difference [SE], 2.6 [1.1]; P = .02). Patients of female physicians had more participatory visits (adjusted mean [SE] PDM score for female, 62.4 [1.3] vs male, 59.5 [3.1]; P = .03), but gender concordance between physicians and patients was not significantly related to PDM score (unadjusted mean [SE] PDM score, 76.0 [1.0] for concordant vs 74.5 [0.9] for discordant; P = .12). Patient satisfaction was highly associated with PDM score within all race/ethnicity groups. CONCLUSIONS Our data suggest that African American patients rate their visits with physicians as less participatory than whites. However, patients seeing physicians of their own race rate their physicians' decision-making styles as more participatory. Improving cross-cultural communication between primary care physicians and patients and providing patients with access to a diverse group of physicians may lead to more patient involvement in care, higher levels of patient satisfaction, and better health outcomes.

[1]  C. Moorehead All rights reserved , 1997 .

[2]  J. Eisenberg Sociologic influences on decision-making by clinicians. , 1979, Annals of internal medicine.

[3]  J. Goodwin,et al.  Patient Characteristics That Influence Physician Behavior , 1982, Medical care.

[4]  N. Lurie,et al.  Teaching residents to care for vulnerable populations in the outpatient setting , 1990, Journal of general internal medicine.

[5]  A. Barsky,et al.  Evaluating the interview inprimary care medicine , 1980 .

[6]  M. Lipkin,et al.  Sex Differences in Patients' and Physicians' Communication During Primary Care Medical Visits , 1991, Medical care.

[7]  Barbara Gandek,et al.  Characteristics of Physicians with Participatory Decision-Making Styles , 1996, Annals of Internal Medicine.

[8]  Mark V. Williams,et al.  Obstacles predicting lack of a regular provider and delays in seeking care for patients at an urban public hospital. , 1994, JAMA.

[9]  A. Flood,et al.  Relationship Between Patient Race and the Intensity of Hospital Services , 1987, Medical care.

[10]  D. R. Levy White doctors and black patients: influence of race on the doctor-patient relationship. , 1985, Pediatrics.

[11]  F. Earls,et al.  Treatment-seeking for depression by black and white Americans. , 1987, Social science & medicine.

[12]  T. Hu,et al.  Ethnic populations in public mental health: services choice and level of use. , 1991, American journal of public health.

[13]  Howard Waitzkin,et al.  Differences in clinical communication by gender , 1999, Journal of General Internal Medicine.

[14]  R. Hayward,et al.  Regular source of ambulatory care and access to health services. , 1991, American journal of public health.

[15]  S. Vernon,et al.  Prevalence of treated and untreated psychiatric disorders in three ethnic groups. , 1982, Social science & medicine.

[16]  A. Barsky,et al.  Evaluating the interview in primary care medicine. , 1980, Social science & medicine. Medical psychology & medical sociology.

[17]  Barbara Gandek,et al.  Patient and Visit Characteristics Related to Physicians' Participatory Decision-Making Style: Results from the Medical Outcomes Study , 1995, Medical care.

[18]  J P Mullooly,et al.  Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. , 1997, JAMA.

[19]  M. Shapiro,et al.  Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles County, 1986 through 1988. , 1995, American journal of public health.

[20]  C. Kjellstrand Age, sex, and race inequality in renal transplantation. , 1988, Archives of internal medicine.

[21]  P. Diehr,et al.  Mental Health Services: Utilization by Low Income Enrollees in a Prepaid Group Practice Plan and in an Independent Practice Plan , 1979, Medical care.

[22]  R. Wasserman,et al.  Pediatric clinicians' support for parents makes a difference: an outcome-based analysis of clinician-parent interaction. , 1984, Pediatrics.

[23]  D. Roter,et al.  The relationship of physician medical interview style to patient satisfaction. , 1991, The Journal of family practice.

[24]  S. Kaplan,et al.  Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease , 1989, Medical care.

[25]  J. Mckinlay,et al.  Non-medical influences on medical decision-making. , 1996, Social science & medicine.

[26]  J. Bensing,et al.  Gender and communication style in general practice. Differences between women's health care and regular health care. , 1998, Medical care.

[27]  R. Scheffler,et al.  Demand analysis of mental health service use among ethnic subpopulations. , 1989, Inquiry : a journal of medical care organization, provision and financing.

[28]  Hosmer,et al.  Medicare treatment differences for blacks and whites. , 1997, Medical care.

[29]  L. Verbrugge,et al.  Physician Treatment of Men and Women Patients: Sex Bias or Appropriate Care? , 1981, Medical care.

[30]  A M Epstein,et al.  Delayed access to health care: risk factors, reasons, and consequences. , 1991, Annals of internal medicine.

[31]  Judith A. Hall,et al.  Patient-physician communication: A descriptive summary of the literature , 1988 .

[32]  E. Keeler,et al.  Health care for black and poor hospitalized Medicare patients. , 1994, JAMA.

[33]  E. H. Lin Intraethnic characteristics and the patient-physician interaction: "cultural blind spot syndrome". , 1983, The Journal of family practice.

[34]  R. Lavizzo-Mourey,et al.  Cultural Competence: Essential Measurements of Quality for Managed Care Organizations , 1996, Annals of Internal Medicine.

[35]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[36]  M. Stewart,et al.  Communication patterns of primary care physicians. , 1997, JAMA.

[37]  John E. Ware,et al.  Expanding Patient Involvement in Care , 1985 .

[38]  E. Moy,et al.  Physician race and care of minority and medically indigent patients. , 1995, JAMA.

[39]  K. Vranizan,et al.  The role of black and Hispanic physicians in providing health care for underserved populations. , 1996, The New England journal of medicine.

[40]  A. Epstein,et al.  Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. , 1989, JAMA.

[41]  D. Carlisle,et al.  The entry of African-American students into US medical schools: an evaluation of recent trends. , 1998, Journal of the National Medical Association.

[42]  T. Quill,et al.  Recognizing and adjusting to barriers in doctor-patient communication. , 1989, Annals of internal medicine.

[43]  Arthur Kleinman,et al.  Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research , 1978 .

[44]  J. Whittle,et al.  Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. , 1993, The New England journal of medicine.

[45]  M. Rivo,et al.  Black/white comparisons of deaths preventable by medical intervention: United States and the District of Columbia 1980-1986. , 1990, International journal of epidemiology.

[46]  W. Hadden,et al.  The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. , 1993, The New England journal of medicine.

[47]  D A Pendleton,et al.  The communication of medical information in general practice consultations as a function of patients' social class. , 1980, Social science & medicine. Medical psychology & medical sociology.

[48]  K Y Liang,et al.  Longitudinal data analysis for discrete and continuous outcomes. , 1986, Biometrics.

[49]  L. Aiken,et al.  Access to medical care for black and white Americans. A matter of continuing concern. , 1989, JAMA.

[50]  J. Mathews,et al.  The communication process in clinical settings. , 1983, Social science & medicine.

[51]  K A Schulman,et al.  The effect of race and sex on physicians' recommendations for cardiac catheterization. , 1999, The New England journal of medicine.

[52]  Judith A. Hall,et al.  Meta-analysis of Correlates of Provider Behavior in Medical Encounters , 1988, Medical care.

[53]  Mull Jd CROSS-CULTURAL COMMUNICATION IN THE PHYSICIAN'S OFFICE , 1993 .