Abstract
Objectives
To determine what roles patient–provider and patient–staff racial concordance play on patients’ perceptions within the health care setting.
Design, Setting, Participants
Data from the Commonwealth Fund 2001 Quality of Care telephone survey. Analysis focused on the subsample of 6,066 adults who live in the continental United States and who reported having a regular provider or a usual source of care (n = 4,762).
Measurements and Results
We analyzed patients’ responses about perceptions of disrespect, unfair treatment because of race and language, and the belief that he/she would have received better treatment if he/she belonged to a different race. We compared these perceptions of mistreatment with provider and staff racial concordance, controlling for sociodemographic variables. Contrary to our hypothesis, Hispanics were more likely to report being treated with disrespect if in a concordant relationship with their provider than if in a nonconcordant one (odds ratio [OR] 2.42, P < .01). Asians were less likely to report being treated unfairly because of race if in racially concordant relationships with providers than if in nonconcordant ones (P < .05). Hispanics were also less likely to perceive unfair treatment because of language when in concordant relationships with staff as compared to nonconcordant relationships with staff (P < .05).
Conclusions
Patients’ perceptions of health care relationships may partially depend on racial concordance with providers and staff. The nature of the association between racial concordance and perceived disrespect varies by racial group, indicating that other race-specific factors may also need to be examined.
Similar content being viewed by others
REFERENCES
Smedley BD, Stith AY, Nelson AR, eds. Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Sciences Policy. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington DC: National Academy Press; 2002.
Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000;57(Suppl 1):108–45.
East MA, Peterson ED. Understanding racial differences in cardiovascular care and outcomes: issues for the new millennium. Am Heart J. 2000;139:764–6.
Barnett E, Halverson J. Disparities in premature coronary heart disease mortality by region and urbanicity among black and white adults ages 35–64, 1985–1995. Public Health Rep. 2000;115:52–64.
LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and White cardiac patients. Med Care Res Rev. 2000;57(Suppl 1):146–61.
Blanchard J, Lurie N. R-E-S-P-E-C-T: patient reports of disrespect in the health care setting and its impact on care. J Fam Pract. 2004;53(9):721–30.
LaVeist TA, Nuru-Jeter A, Jones KE. The association of doctor–patient race concordance with health services utilization. J Public Health Policy. 2003;24(3–4):312–23.
Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient–physician relationship. JAMA. 1999;282(6):583–9.
Kaplan SH, Greenfield S, Gandex B, Rogers WH, Ware JE. Characteristics of physicians with participatory decision-making styles. Ann Intern Med. 1996;124:497–504.
Putnam SM, Stiles WB, Jacob MC, James SA. Patient exposition and physician explanation in initial medical interviews and outcomes of clinical visits. Med Care. 1985;23:74–83.
Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907–15.
Saha S, Taggart SH, Komaromy M, Bindman AB. Do patients choose physicians of their own race? Health Aff. 2000;19(4):76–83.
Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient–physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159(9):997–1004.
LaVeist TA, Carroll T. Race of physician and satisfaction with care among African-American patients. J Natl Med Assoc. 2002;94(11):937–43.
LaVeist TA, Nuru-Jeter A. Is doctor-patient race concordance associated with greater satisfaction with care? J Health Soc Behav. 2002;43(3):296–306.
Garcia JA, Paterniti DA, Romano PS, Kravitz RL. Patient preferences for physician characteristics in university-based primary care clinics. Ethn Dis. 2003;13(2):259–67.
O’Malley KJ, Haidet P, Sharf B, et al. Trust in physician, facility, and system: qualitative differences between ethnic groups. SGIM 2003 Annual Meeting.
Princeton Survey Research Associates for Commonwealth Fund, 2002. Methodology: Survey on disparities in quality of health care. Spring 2001.
STATA Version 6.0. College Station, Tex: STATA Corporation; 1999.
Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. New Engl J Med. 2004;351(6);575–84.
Malat J, Van Ryn M. African-American preference for same-race healthcare providers: the role of healthcare discrimination. Ethn Dis. 2005;15(4):740–47.
Gray B, Stoddard J. Patient-physician pairing: does racial and ethnic congruity influence selection of a regular physician. J Commun Health. 1997;22(4):247–59.
Cohen JJ. The consequences of premature abandonment of affirmative action in medical school admissions. JAMA. 2003;289:1143–9.
Lieu TA, Finkelstein JA, Lozano P, et al. Cultural competence policies and other predictors of asthma care quality for Medicaid-insured children. Pediatrics. 2004;114(1):e102–10.
Flores G, Gee D, Kastner B. The teaching of cultural issues in U. S. and Canadian medical schools. Acad Med. 2000;75:451–5.
Pena DE, Munoz C, Grumbach K. Cross-cultural education in U.S. medical schools: development of an assessment tool. Acad Med. 2003;78:615–22.
Ferguson WJ, Keller DM, Haley HL, Quirk M. Developing culturally competent community faculty: a model program. JAMA. 2003;78:1221–8.
Hampers LC, McNulty JE. Professional interpreters and bilingual physicians in a pediatric emergency department: effect on resource utilization. Arch Pediatr Adolesc Med. 2002;156:1108–13.
Acknowledgment
This paper was written with the support of the Commonwealth Fund, which provided data and funding.
Conflict of Interest: None disclosed.
Author information
Authors and Affiliations
Corresponding author
Additional information
The topics discussed in this paper were presented as an abstract at a conference for the Society of Academic Emergency Medicine, May 2006.
Rights and permissions
About this article
Cite this article
Blanchard, J., Nayar, S. & Lurie, N. Patient–Provider and Patient–Staff Racial Concordance and Perceptions of Mistreatment in the Health Care Setting. J GEN INTERN MED 22, 1184–1189 (2007). https://doi.org/10.1007/s11606-007-0210-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-007-0210-8