Perceptions of Respect From Clinicians by Patients in Racial and Ethnic Minority Groups With Eye Disease

Abstract

IMPORTANCEThe perception of being treated with respect by clinicians may be a driver of disparities in individuals in racial and ethnic minoritie groups with eye diseases. Understanding these drivers may help identify potential interventions to reduce eye health disparities to prevent vision loss and blindness.OBJECTIVE To evaluate the association between racial and ethnic minority status and the perception of being treated with respect by clinicians. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional analysis of a nationally representative cohort study using data from the National Health Interview Survey (NHIS) included participants in the 2017 survey with complete data on outcomes, associated factors, and covariates. Data analysis took place from January 2021 to February 2021. Using a population-based survey conducted in the US in 2017 by the US census bureau on behalf of the National Center for Health Statistics, NHIS study participants (age Ն18 years) who self-reported having an eye disease (macular degeneration, diabetic retinopathy [DR], glaucoma, cataracts) were included, and patients who self-reported as Black, Asian, other/multiple races, or Hispanic ethnicity were considered to be in racial and ethnic minority groups.MAIN OUTCOMES AND MEASURES Multivariable logistic regression models were used to evaluate the association of minority status with self-reported "always" being treated with respect by clinicians and self-reported "always" being asked about opinions/beliefs about medical care. RESULTSParticipants in racial and ethnic minority groups had 23% lower odds of reporting being treated with respect compared with non-Hispanic White patients (adjusted odds ratio [AOR], 0.77; 95% CI, 0.61-0.97; P = .03). A minority of participants had 66% higher odds of reporting being asked about their beliefs (AOR, 1.66; 95% CI, 1.39-1.98; P < .001). For all patients, being asked about opinions/beliefs by their clinician was associated with a 5.8 times higher odds of reporting being treated with respect (AOR, 5.80; 95% CI,; P < .001). CONCLUSIONS AND RELEVANCEIn this nationally representative US population of patients with eye diseases, being a patient in a racial or ethnic minority group was associated with feeling less respected by health care professionals compared with non-Hispanic White patients. Asking about opinions and beliefs, regardless of race or ethnicity, is associated with patients feeling that they are treated with respect.

Skin Color Representation in Ophthalmology Textbooks

“…Beyond direct diagnostic delays from lack of familiarity with pathology among a diverse range of skin tones, uncertainty surrounding diagnosing diseases in skin of color may damage the patient-physician relationship and further perpetuate physician mistrust. This is of particular concern for patients from racial and ethnic minority groups who have historically experienced mistreatment by health care institutions and have reported feeling less respected by their physicians compare to their white counterparts [ 15 , 16 ]. These concerns underscore the importance of ensuring that physicians and medical trainees alike are exposed to disease presentations in different skin tones and are taught to consider all possible diagnoses upon encountering a patient, regardless of their skin tone.…”

Evaluating the Relationship between Neighborhood-Level Social Vulnerability and Patient Adherence to Ophthalmology Appointments

“…49 Within eye care, lack of trust, empathy, or patient-doctor communication have each been emphasized as barriers to utilization in populations at high risk of vision loss, 6 and minorities have reported feeling less respected by health care professionals compared to non-Hispanic Whites. 50 There have been several calls to diversify the workforce to improve patient care and focus on improving health equity through research 51, 52 as both ophthalmology and the field of medicine currently lack diversity. 53 Given these findings, it is imperative for providers to acknowledge that structural racism exists in healthcare, recognize and work toward ways to address implicit bias, and diversify the workforce.…”

Beyond Accessibility in Exploring Access to Eye Care to Achieve Vision Health Equity

“…4 Lack of respect may be associated with reduced uptake of essential eye care services thus perpetuating eye health disparities. 4 Availability focuses on the supply and demand; in other words, if the type of eye care services needed is matched to the available services offered. 2 In local community health centers, frequented by at-risk populations, eye care services are lacking or, if available, do not reflect care for the eye diseases that are prevalent in these populations, such as glaucoma care.…”

“…Patients who identify as racial and ethnic minorities and patients with lower socioeconomic status are more likely to report lack of respect in the patient-physician relationship . Lack of respect may be associated with reduced uptake of essential eye care services thus perpetuating eye health disparities …”