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Pages 160-179

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From page 160...
... 4 Assessing Potential Sources of Racial and Ethnic Disparities in Care: The Clinical Encounter Previous chapters have assessed the extent of racial and ethnic disparities in healthcare, and have identified potential sources of these disparities. Disparities are found to arise from an historic and social context in which racial and ethnic minorities received inferior healthcare, reflecting broader socioeconomic disadvantage among minorities and societal discrimination.
From page 161...
... 161 THE CLINICAL ENCOUNTER fine discrimination in varying ways, with some focusing on intent and others emphasizing disparate impact. Three mechanisms might be operative in producing discriminatory patterns of healthcare from the provider's side of the exchange: 1)
From page 162...
... 162 UNEQUAL TREATMENT and the weighting of these data on various dimensions of salience. The assembly and use of these data are affected by many influences, including various heuristics that introduce significant problems for recall and weighting.
From page 163...
... 163 THE CLINICAL ENCOUNTER gests that differences in care may result from conscious or unconscious biases on the part of physicians and other healthcare providers. Schulman et al.
From page 164...
... 164 UNEQUAL TREATMENT consistently among black patients reflect an effort to provide more appropriate care to these patients" (Schulman, Berlin, and Escarce, 1999, p.
From page 165...
... 165 THE CLINICAL ENCOUNTER how physicians' race, ethnicity, or gender may influence their attitudes toward and perceptions of patients. Another experimental study, using first- and second-year medical students as subjects, assessed whether the race and gender of hypothetical patients influenced students' perceptions of presenting symptoms.
From page 166...
... 166 UNEQUAL TREATMENT patients (57% white and 43% African American) following post-angiogram hospital visits.
From page 167...
... 167 THE CLINICAL ENCOUNTER now substantial weight of available scientific evidence) to be discriminatory?
From page 168...
... 168 UNEQUAL TREATMENT tor believes that the prior probability of either patient having heart problems is low and regards it to be the same for both patients. Now, suppose the Latino and the white patient both experience exactly the same symptom(s)
From page 169...
... 169 THE CLINICAL ENCOUNTER comply less frequently, since they anticipate that the care will be less wellmatched to their needs. Provider Beliefs and Stereotypes The mechanism of stereotypes is the most complicated of the three discussed in this chapter.
From page 170...
... 170 UNEQUAL TREATMENT biases may exist in overt forms, as represented by traditional forms of bigotry. However, because of their origins in virtually universal social categorization processes, they may also exist, often unconsciously, among people who strongly endorse egalitarian principles and truly believe that they are not prejudiced (Dovidio and Gaertner, 1998)
From page 171...
... 171 THE CLINICAL ENCOUNTER chological bond and feelings of "oneness" that facilitate the arousal of empathy in response to others' needs or problems. As a consequence, assistance is offered more readily to in-group than to out-group members.
From page 172...
... 172 UNEQUAL TREATMENT shape interpretations, influence how information is recalled, and guide expectations and inferences in systematic ways, they tend to be self-perpetuating. They also can produce self-fulfilling prophecies in social interaction, in which the stereotypes of the perceiver influence the interaction in ways that conform to stereotypical expectations (Jussim, 1991)
From page 173...
... 173 THE CLINICAL ENCOUNTER exist even among highly educated whites who support egalitarian ideals and are not consciously racially prejudiced (Biernat and Dovidio, 2000)
From page 174...
... 174 UNEQUAL TREATMENT van Ryn and Burke (2000) are correct in their belief that African Americans are less likely to comply with treatment?
From page 175...
... 175 THE CLINICAL ENCOUNTER higher rate of refusal of recommended treatments may reflect patients' experiences of discrimination in other sectors or mistrust of authority. Some mistrust and refusal, however, might be a "rational" reaction to explicit discrimination, aversion, or disregard displayed by the provider.
From page 176...
... 176 UNEQUAL TREATMENT tion and cognitive resources -- are those that frequently occur in the context of doctor-patient interactions. We supported these propositions with research and illustrated their likely effects.
From page 177...
... 177 THE CLINICAL ENCOUNTER resources. These studies generally find that disparities remain and cannot be fully explained by these variables.
From page 178...
... 178 UNEQUAL TREATMENT friends with") , even after controlling for patients' socioeconomic status, personality variables, and perceived social support (van Ryn and Burke, 2000)
From page 179...
... 179 THE CLINICAL ENCOUNTER should be developed by patients and their families on the basis of full and accurate information presented by a healthcare provider, but the acquisition and use of such information may be influenced by the quality of patient-provider communication and interaction, patients' expectations, values and beliefs, as well as the values and beliefs of patients' communities. To the extent that minority patients are more likely than whites to refuse treatment, such behaviorally expressed preferences may be considered a source of healthcare disparities.

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