Unequal Treatment Confronting Racial and Ethnic Disparities in Health Care (2003) / Chapter Skim
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Patient-Provider Communication: The Effect of Race and Ethnicity on Process and Outcomes of Healthcare Lisa A Cooper, M.D., M.P.H.
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553 PATIENT-PROVIDER COMMUNICATION sicians, and other healthcare providers is needed. The reciprocal nature of the patient-physician relationship is a critical factor that should be highlighted in future work.
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554 UNEQUAL TREATMENT Sun et al., 2000; Baker et al., 1996)
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555 PATIENT-PROVIDER COMMUNICATION family, inclusion of traditional healers or folk remedies, use of community health workers)
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556 UNEQUAL TREATMENT Physician Role Obligations and Medicine's Unwritten Social Contract It has been argued that the basis of trust between patients and their physicians lies in the physician's dedication to "universalism," that is, the responsibility to treat all patients alike without regard to particular attributes or ascribed traits (Parsons, 1951)
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557 PATIENT-PROVIDER COMMUNICATION communicated these expectations to their physicians. In these instances, effective tailoring of pain management maximized medical care.
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558 UNEQUAL TREATMENT mon, owing to typically small physician samples in communication studies (Roter and Hall, 1992)
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559 PATIENT-PROVIDER COMMUNICATION ciated with patient ratings of physicians' participatory decision-making (PDM) style.
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560 UNEQUAL TREATMENT One study found that although male and female physicians did not differ in how much biomedical information they conveyed, the male physicians' talk included less psychosocial discussion. Male physicians also asked fewer questions of all sorts, engaged in less partnership-building behaviors (enlisting the patient's active participation and reducing physician dominance)
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561 PATIENT-PROVIDER COMMUNICATION enhance communication between physicians of lower social class origin with patients of similar social class backgrounds, or to impede the ability of physicians from poorer backgrounds to communicate with patients of higher social classes (Waitzkin and Waterman, 1974)
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562 UNEQUAL TREATMENT Hollingshead and Redlich speculate that the analytic psychiatrists "like all phenomenal upward mobile persons, those who have achieved their present class positions largely through their own efforts and abilities have passed through a social, possibly also psychological, transformation" (Hollingshead and Redlich, 1958, p.
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563 PATIENT-PROVIDER COMMUNICATION norms or lack of confidence, such patients do not request or demand a high level of performance from their physicians (which would, of course, confirm whatever stereotypes the physicians may already have)
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564 UNEQUAL TREATMENT concerned about the significance of their pain for future health and resisted pain medication for fear that it would mask a significant symptom. It is also important to note that appropriate treatment was tied to the way in which patients presented their pain.
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565 PATIENT-PROVIDER COMMUNICATION that doctors recognize a connection between their own attitudes and behavior (Roter and Hall, 1992)
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566 UNEQUAL TREATMENT process. The Medical Outcomes Study (MOS)
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567 PATIENT-PROVIDER COMMUNICATION social norms for communication across racial groups, particularly for African-American birth cohorts (Satcher, 1973)
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568 UNEQUAL TREATMENT cians discourages verbal assertiveness (Cartwright, 1967)
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569 PATIENT-PROVIDER COMMUNICATION ents received worse care on all accounts from their physicians. Also noted in this study was that low-income families did not have as consistently negative experiences as did the children of the poorly educated.
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570 UNEQUAL TREATMENT pendable" category of interaction in the service of devoting time to more pressing medical issues, physicians may unknowingly undermine their relationships with the very patients to whom the quality of the relationship may matter most. To the extent that ethnic minority patients have poorer access to healthcare, present for care at later stages of disease, and have poorer health status, the impact of their health status may further exacerbate the communication problems they are already experiencing due to cultural or social class differences from their physicians (Hall and Roter, 2002)
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571 PATIENT-PROVIDER COMMUNICATION ceptions surrounding illiteracy may hamper such recognition. In their comprehensive overview of challenges in teaching patients with low literacy skills, Doak et al.
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572 UNEQUAL TREATMENT of speech used by literate and low-literate populations (Roter, Rudd, and Comings, 1998)
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573 PATIENT-PROVIDER COMMUNICATION tween physicians and patients on PDM, we stratified patients according to the race/ethnicity of their physicians. We then measured the relationship between PDM style and patient race within each physician race group, adjusting for patient age, gender, education, marital status, health status, and length of the relationship.
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574 UNEQUAL TREATMENT Another study by Saha and colleagues, using The Commonwealth Fund 1994 National Comparative Survey of Minority Healthcare, showed that black and Hispanic respondents who had the ability to choose their physician were more likely to choose a racially or ethnically concordant physician (Saha et al., 2000)
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575 PATIENT-PROVIDER COMMUNICATION cine since the time of the Greeks (Emanuel, 1961) and in the modern medical and social sciences literature for the past 50 years (Engel, 1977; Freidson, 1970; Parsons, 1951; Szasz and Hollender, 1956)
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576 UNEQUAL TREATMENT mal training in communication skills (Epstein, Campbell, Cohen-Cole, McWhinney, and Smilkstein, 1993)
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577 PATIENT-PROVIDER COMMUNICATION comes. In these studies, a research assistant reviewed the medical record with the patient, helped the patient identify decisions to be made, rehearsed negotiation skills, encouraged the patient to ask questions, reviewed obstacles such as embarrassment and intimidation, and after the visit gave the patient a copy of the medical record for that visit.
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578 UNEQUAL TREATMENT ing other ethnic minority groups, such as Hispanics and Asian Americans, are needed. Moreover, there is a paucity of research on the impact of using institutional resources (direct services, cultural homophilly, and institutional accommodations)
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579 PATIENT-PROVIDER COMMUNICATION among patient and physician age, gender, and ethnicity and their impact on patient-physician communication. The Role of Cross-Cultural Training for Healthcare Professionals Researchers and medical educators have developed models for crosscultural training of healthcare professionals (Sue, Zane, and Young, 1994; Gardenschwartz and Rowe, 1998; Carrillo, Green, and Betancourt, 1999; Loudon et al., 1999)
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580 UNEQUAL TREATMENT Cultural skill is the ability to collect relevant cultural data regarding clients' health histories and presenting problems, as well as accurately performing a culturally specific physical assessment. The literature offers several assessment tools that healthcare providers can use when conducting cultural assessments (Berlin and Fowkes, 1983; Kleinman, Eisenberg, and Good, 1978; Buchwald et al., 1994)
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581 PATIENT-PROVIDER COMMUNICATION distinguishes them from the majority culture. Ethnic minorities, the elderly, the poor, and the non-functionally literate are victims of disparities in health and the receipt of health services (Agency for Healthcare Policy and Research, 1999)
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582 UNEQUAL TREATMENT Arora NK, McHorney CA.
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583 PATIENT-PROVIDER COMMUNICATION Carlisle DM, Leake BD, Shapiro MF.
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584 UNEQUAL TREATMENT DiMatteo MR.
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585 PATIENT-PROVIDER COMMUNICATION Escarce JJ, Epstein KR, Colby DC, Schwartz JS.
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586 UNEQUAL TREATMENT Greene MG, Adelman RD.
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587 PATIENT-PROVIDER COMMUNICATION Hall JA, Roter DL.
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588 UNEQUAL TREATMENT Lazare, A, Putnam SM, Lipkin M
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589 PATIENT-PROVIDER COMMUNICATION Novack DH, Dube C, Goldstein MG.
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590 UNEQUAL TREATMENT Roter D
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591 PATIENT-PROVIDER COMMUNICATION Roter DL, Stewart M, Putnam S, Lipkin M, Stiles W, Inui T
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592 UNEQUAL TREATMENT Suchman AL, Roter DL, Green M, Lipkin M, Jr.
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593 PATIENT-PROVIDER COMMUNICATION Weiss BD, Coyne C
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