Patient-Physician Racial Concordance and the Perceived Quality and Use of Health Care

Saha, Somnath; Komaromy, Miriam; Koepsell, Thomas D.; Bindman, Andrew B.

doi:10.1001/archinte.159.9.997

Cited by 912 publications

(582 citation statements)

References 29 publications

(26 reference statements)

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“…These findings are consistent with published data showing that gender minorities report limited provider cultural competency, frequent denial of needed healthcare services, and overt harassment in healthcare settings [1,3,4,20]. Similarly, individuals born with differences of sex development have distinct medical needs that are often inadequately addressed or addressed in a way that enforces a binary model of sex and gender, provoking lifelong psychological trauma [21–23], and/or physical sequelae [6,24]. Our findings suggest that enhanced provider training to competently and sensitively serve these particular populations is needed.…”

Section: Discussionsupporting

confidence: 89%

Sexual and gender minority health in medical curricula in new England: a pilot study of medical student comfort, competence and perception of curricula

Zelin

Hastings

Beaulieu‐Jones

et al. 2018

Medical Education Online

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Background: Sexual and gender minority (SGM) individuals experience high rates of harassment and discrimination when seeking healthcare, which contributes to substantial healthcare disparities. Improving physician training about gender identity, sexual orientation, and the healthcare needs of SGM patients has been identified as a critical strategy for mitigating these disparities. In 2014, the Association of American Medical Colleges (AAMC) published medical education competencies to guide undergraduate medical education on SGM topics.Objective: Conduct pilot study to investigate medical student comfort and competence about SGM health competencies outlined by the AAMC and evaluate curricular coverage of SGM topics.Design: Six-hundred and fifty-eight students at New England allopathic medical schools (response rate 21.2%) completed an anonymous, online survey evaluating self-reported comfort and competence regarding SGM health competencies, and coverage of SGM health in the medical curriculum.Results: 92.7% of students felt somewhat or very comfortable treating sexual minorities; 68.4% felt comfortable treating gender minorities. Most respondents felt not competent or somewhat not competent with medical treatment of gender minority patients (76.7%) and patients with a difference of sex development (81%). At seven schools, more than 50% of students indicated that the curriculum neither adequately covers SGM-specific topics nor adequately prepares students to serve SGM patients.Conclusions: The prevalence of self-reported comfort is greater than that of self-reported competence serving SGM patients in a convenience sample of New England allopathic medical students. The majority of participants reported insufficient curricular preparation to achieve the competencies necessary to care for SGM patients. This multi-institution pilot study provides preliminary evidence that further curriculum development may be needed to enable medical students to achieve core competencies in SGM health, as defined by AAMC. Further mixed methods research is necessary to substantiate and expand upon the findings of this pilot study. This pilot study also demonstrates the importance of creating specific evaluation tools to assess medical student achievement of competencies established by the AAMC.

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Section: Discussionsupporting

confidence: 89%

Sexual and gender minority health in medical curricula in new England: a pilot study of medical student comfort, competence and perception of curricula

Zelin

Hastings

Beaulieu‐Jones

et al. 2018

Medical Education Online

View full text Add to dashboard Cite

show abstract

“…Expanding this framework to include testing for the presence and effect of stereotypes is also warranted. There is a literature on "racial matching" between physicians and patients concerned with whether patients (or doctors) prefer contact with their own race, and if this match has any effect on treatment (Chen et al, 2001;Cooper-Patrick et al, 1999;Saha et al, 1999). While communication could well be part of the story, attempting to interpret this literature or conduct new studies of this type to investigate bias and stereotyping is one fruitful direction to pursue.…”

Section: Discussionmentioning

confidence: 99%

“…Stinson and Thurston (2002) find that in ZIP codes where fewer people speak English, Hispanic doctors have more Hispanic patients than non-Hispanic patients. Other studies focused on the benefits of racial matching conclude that patients express higher satisfaction with the care received when treated by a physician of their same race/ethnicity (Cooper-Patrick et al, 1999); obtain more preventive care (Saha et al, 1999) and stay in treatment longer (Takeuchi et al, 1995;Sue et al, 1991).…”

Section: Health Care Markets and The Long-term Effects Of Prejudicementioning

confidence: 99%

Prejudice, clinical uncertainty and stereotyping as sources of health disparities

Balsa

McGuire

2003

Journal of Health Economics

267

194

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“…Such findings have led some to explore whether demographic concordance between physician and patient may facilitate better relationships and more positive health care interactions because the physician and patient have some element of shared identity. Some evidence supports this claim, particularly with regard to racial concordance (Cooper et al, 2003;Cooper-Patrick, Gallo, Gonzales, Vu, Powe, Nelson et al 1999;LaVeist & Nuru-Jeter, 2002;Saha, Komaromy, Koepsell & Bindman, 1999). Although there is little evidence indicating that physicians provide better care to patients similar in age or gender, we nevertheless examined whether differences in physicians' communication and perceptions are uniquely related to physician-patient concordance with respect to race, age, and gender (see Figure 1).…”

Section: Conceptual Framework: An Ecological Approachmentioning

confidence: 99%

Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?

Street

Gordon

Haidet

2007

Social Science & Medicine

442

359

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Although physicians' communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with patients. Moreover, while any number of factors may affect the communication process, few studies have analyzed these effects collectively in order to identify the most powerful influences on physician communication and perceptions. Adopting an ecological approach, this investigation examined: (a) the relationships of physicians' patient-centered communication (informative, supportive, partnership-building) and affect (positive, contentious) on their perceptions of the patient, and (b) the degree to which communication and perceptions were affected by the physicians' characteristics, patients' demographic characteristics, physician-patient concordance, and the patient's communication. Physicians (N = 29) and patients (N = 207) from 10 outpatient settings in the United States participated in the study. From audio-recordings of these visits, coders rated the physicians' communication and affect as well as the patients' participation and affect. Doctors were more patientcentered with patients they perceived as better communicators, more satisfied, and more likely to adhere. Physicians displayed more patient-centered communication and more favorably perceived patients who expressed positive affect, were more involved, and who were less contentious. Physicians were more contentious with black patients, whom they also perceived as less effective communicators and less satisfied. Finally, physicians who reported a patient-centered orientation to the doctor-patient relationship also were more patient-centered in their communication. The results suggest that reciprocity and mutual influence have a strong effect on these interactions in that more positive (or negative) communication from one participant leads to similar responses from the other. Physicians' encounters with black patients revealed communicative difficulties that may lower quality of care for these patients.

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Patient-Physician Racial Concordance and the Perceived Quality and Use of Health Care

Cited by 912 publications

References 29 publications

Sexual and gender minority health in medical curricula in new England: a pilot study of medical student comfort, competence and perception of curricula

Sexual and gender minority health in medical curricula in new England: a pilot study of medical student comfort, competence and perception of curricula

Prejudice, clinical uncertainty and stereotyping as sources of health disparities

Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?

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