Abstract
African Americans and Latinos use services that require a doctor’s order at lower rates than do whites. Racial bias and patient preferences contribute to disparities, but their effects appear small. Communication during the medical interaction plays a central role in decision making about subsequent interventions and health behaviors. Research has shown that doctors have poorer communication with minority patients than with others, but problems in doctor-patient communication have received little attention as a potential cause, a remediable one, of health disparities. We evaluate the evidence that poor communication is a cause of disparities and propose some remedies drawn from the communication sciences.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bach PB, Cramer LD, Warren JL, Begg CB. Racial differences in the treatment of early-stage lung cancer. N Engl J Med. 1999;341:1198–205.
Petersen LA, Wright SM, Peterson ED, Daley J. Impact of race on cardiac care and outcomes in veterans with acute myocardial infarction. Med Care. 2002;40(suppl):186–96.
[No authors listed]. Coronary heart disease mortality trends among whites and blacks—Appalachia and United States, 1980–1993. Morb Mortal Wkly Rep. 1998;47:1005–8.
Canto JG, Allison JJ, Kiefe CI, et al. Relation of race and sex to the use of reperfusion therapy in Medicare beneficiaries with acute myocardial infarction. N Engl J Med. 2000;342:1094–100.
Pratto F, Bargh JA. Stereotyping based on apparently individuating information: trait and global components of sex stereotypes under attention overload. J Exp Soc Psychol. 1991;127:26, 47.
Kruglanski AW, Freund T. The freezing and unfreezing of lay inferences: effects of impressional primary, ethnic stereotyping, and numerical anchoring. J Exp Soc Psychol. 1983;19:448–68.
Stangor C, Duan C. Effects of multiple task demands upon memory for information about social groups. J Exp Soc Psychol. 1991;27:357–78.
Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.
Schwartz LM, Woloshin S, Welch HG. Misunderstandings about the effects of race and sex on physicians’ referrals for cardiac catheterization. N Engl J Med. 1999;341:279–83.
van Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. 2002;40(suppl):140–51.
Diala CC, Muntaner C, Walrath C, Nickerson K, LaViest T, Leaf P. Racial/ethnic differences in attitudes toward seeking professional mental health services. Am J Public Health. 2001;91:805–7.
Shepardson LB, Gordon HS, Ibrahim S, Harper DL, Rosenthal GE. Racial variation in the use of do-not-resuscitate orders. J Gen Intern Med. 1999;14:15–20.
Oddone EZ, Horner RD, Lipscomb J, et al. Understanding racial variation in the use of carotid endarterectomy: the role of aversion to surgery. J Natl Med Assoc. 1998;90:25–33.
Braddock CH, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice. JAMA. 1999;282:2313–20.
Quill TE, Brody H. Physician recommendations and patient autonomy: findings and balance between physician power and patient choice. Ann Intern Med. 1996;125:763–9.
Bartlett EE, Grayson M, Barker R, Levine DM, Golden A, Libber S. The effects of physician communication skills on patient satisfaction, recall, and adherence. J Chronic Dis. 1984;37:755–64.
Blendon RJ, Alken LH, Freeman HE, Corey CR. Access to medical care for black and white Americans: a matter of continuing concern. JAMA. 1989;261:278–80.
Kaplan SH, Greenfield S, Gandek B, Rogers WH, Ware JE. Characteristics of physicians with participatory decision-making styles. Ann Intern Med. 1996;124:497–504.
Kaplan SH, Gandek B, Greenfield S, Rogers W, Ware JE. Patient and visit characteristics related to physicians’ participatory decision-making style. Results from the Medical Outcomes Study. Med Care. 1995;33:1176–87.
Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9.
Roter DL, Stewart M, Putnam SM, Lipkin M, Stiles W, Inui TS. Communication styles of primary care physicians. JAMA. 1997;277:350–6.
Ong LML, deHaes JCJM, Hoos AM, Lammes FB. Doctor-patient communication: a review of the literature. Soc Sci Med. 1995;40:903–18.
Stewart M. What is a successful doctor-patient interview? A study of interactions and outcomes. Soc Sci Med. 1984;19:167–75.
Orth JE, Stiles WB, Scherwitz L, Hennrikus D, Vallbona C. Patient exposition and provider explanation in routine interviews and hypertensive patients’ blood pressure control. Health Psychol. 1987;6:29–42.
Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277:553–9.
Henbest RJ, Stewart M. Patient-centeredness in the consultation. 2. Does it really make a difference? Fam Pract. 1990;7:28–33.
Kaplan SH, Greenfield S, Ware JE. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(suppl):110–27.
Greenfield S, Kaplan S, Ware JE. Expanding patient involvement in care. Ann Intern Med. 1985;102:520–8.
Greenfield S, Kaplan SH, Ware JE, Yano EM, Frank HJL. Patients’ participation in medical care: effects on blood sugar and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.
Kleinman AM, Eisenberg L, Good B. Culture, illness, and care. Clinical lessons from anthropological and cross-cultural research. Ann Intern Med. 1978;88:251–8.
Geist P, Ray EB, Sharf BF. Communicating Health: Communicating Personal, Political, and Cultural Complexities. Belmont Calif: Wadsworth; 2002.
Kim S, Klingle RS, Sharkey WF, Park HS, Cai D. A test of a cultural model of patients’ motivation for verbal communication in patient-doctor interactions. Commun Monogr. 2000;67:262–83.
Pettigrew TF. Race and class in the 1980s: an interactive view. Daedalus. 1981;110:233–55.
Sharf BF, Kahler J. Victims of the franchise: a culturally sensitive model of teaching patient-doctor communication in the inner city. In: Ray EB. ed. Communication and Disenfranchisement. Social Health Issues and Implications. Mahwah, NJ: Lawrence Erlbaum Associates; 1996:95–115.
Street RL. Physicians’ communication and parents’ evaluations of pediatric consultation. Med Care. 1991;29:46–52.
Street RL. Analyzing communication in medical consultations. Do behavioral measures correspond to patients’ perceptions? Med Care. 1992;30:976–88.
Street RL, Voigt B, Geyer C, Manning T, Swanson GP. Increasing patient involvement in choosing treatment for early breast cancer. Cancer. 1995;76:2275–85.
Boon H, Stewart M. Patient-physician communication assessment instruments: 1986–1996 in review. Patient Educ Couns. 1998;35:162–76.
Rimal RN. Analyzing the physician-patient interaction: an overview of six methods and future research directions. Health Commun. 2001;13:89–99.
Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters. Med Care. 1988;26:657–75.
Street RL. Communication in medical encounters: an ecological perspective. In: Thompson T, Dorsey A, Miller K, Parrott R, eds. The Handbook of Health Communication. Mahwah, NJ: Erlbaum. In press.
Street RL. Communicative styles and adaptations in physician-parent consultations. Soc Sci Med. 1992;34:1155–63.
Capella JN. The management of conversational interaction in adults and infants. In: Knapp ML, Miller GR. eds. Handbook of Interpersonal Communication. 2nd ed. Thousand Oaks, Calif: Sage; 1994:380–418.
Street RL. Active patients as powerful communicators: the linguistic foundation of participation in health care. In: Robinson WP, Giles H. eds. Handbook of Language and Social Psychology. 2nd ed. Chichester: John Wiley; 2001:541–60.
Street RL. Information-giving in medical consultations: the influence of patients’ communicative styles and personal characteristics. Soc Sci Med. 1991;32:541–48.
Heszen-Klemens I, Lapinska E. Doctor-patient interaction, patients’ health behavior, and effects on treatment. Soc Sci Med. 1984;19:9–18.
Carter WB, Inui TS, Kukull WA, Haigh VH. Outcome-based doctor-patient interaction analysis. II. Identifying effective provider and patient behavior. Med Care. 1982;20:550–66.
Merkel WT. Physician perception of patient satisfaction: do doctors know which patients are satisfied? Med Care. 1984;22:453–9.
Fredrickson LG, Bull PE. Evaluation of a patient education leaflet designed to improve communication in medical consultations. Patient Educ Couns. 1995;25:51–7.
Roter DL. Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Educ Monogr. 1977;5:281–315.
Tran AN, Haidet P, Street R, O’Malley KJ, Martin F, Ashton CM. Empowering communication: a community-based intervention for patients. Patient Educ Couns. In press.
Author information
Authors and Affiliations
Corresponding author
Additional information
This project was supported by grant number 3 P01 HS10876 from the Agency for Healthcare Research and Quality. Drs. Haidet, Gordon, and Petersen are recipients of Research Career Development Awards from the Health Services Research and Development Service of the U.S. Department of Veterans’ Affairs. Dr. Collins is supported by a Minority Medical Faculty Development Award from the Robert Wood Johnson Foundation. The authors are the investigators of the Houston Excellence Center to Eliminate Ethnic/Racial Disparities. The Houston EXCEED program is one of nine funded by grants from the U.S. Agency for Healthcare Research and Quality and the NIH Office of Research on Minority Health, and is supported in part by the Department of Veterans’ Affairs and Baylor College of Medicine.
Rights and permissions
About this article
Cite this article
Ashton, C.M., Haidet, P., Paterniti, D.A. et al. Racial and ethnic disparities in the use of health services. J GEN INTERN MED 18, 146–152 (2003). https://doi.org/10.1046/j.1525-1497.2003.20532.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.2003.20532.x