Patients' Beliefs About Racism, Preferences for Physician Race, and Satisfaction With Care

Abstract

PURPOSE Few studies have attempted to link patients' beliefs about racism in the health care system with how they use and experience health care.METHODS Using telephone survey data from a national sample of 1,479 whites, 1,189 African Americans, and 983 Latinos, we explored patients' beliefs about racism, their preferences for the race and ethnicity of their physician, and their satisfaction with that physician. A scale was developed to refl ect patients' beliefs about racism. Race-stratifi ed analyses assessed associations between patients' beliefs, racial preferences for physicians, choice of physician, and satisfaction with care.RESULTS Among African Americans, stronger beliefs about racial discrimination in health care were associated with preferring an African American physician (P <.001). Whereas only 22% of African Americans preferred an African American physician, those who preferred a African American physician and had an African American physician were more likely to rate their physician as excellent than did African Americans who preferred a African American physician but had a non-African American physician (57% vs 20%, P <.001). Latinos with stronger beliefs about discrimination in health care were more likely to prefer a Latino physician (P <.001). One third of Latinos preferred a Latino physician. Though not statistically signifi cant, those who preferred and had a Latino physician rated their physician higher than Latinos who preferred a Latino physician but had a non-Latino physician (40% vs 29%).CONCLUSIONS Many African Americans and Latinos perceive racism in the health care system, and those who do are more likely to prefer a physician of their own race or ethnicity. African Americans who have preferences are more often satisfi ed with their care when their own physicians match their preferences. INTRODUCTIONR acial and ethnic disparities are a major problem in the US health care system. 1 Racial differences have been documented in access to care, receipt of needed medical care, preventive services, and lifesaving technologies. [2][3][4][5][6][7] There is, however, considerable uncertainty around the factors that contribute to racial disparities in health care.8 Although disparities can be explained in part by differences in access to care, socioeconomic conditions, or even bias from health care physicians, the role of patients' beliefs and preferences remains unclear. 9,10 What is the connection between patients' racial beliefs and biases and their preferences for the race of their health caregivers? Shared language, social experiences, and cultural beliefs may drive some preferences. 4,11,12 At the same time, the dubious experience of American medical research in minorities has fostered racial suspicions among some groups. 13 14-16 Although some have documented patients' preferences for clinicians of the same race and a subsequent association with patient satisfaction, the factors that contribute to patients' preferences remain unclear. [15][16][17][18][19][20][21][22] Using a nat...

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