Essay: Minimize physician-patient race concordance

PHA OBJECTIVES
Patients tend to have better outcomes if their doctor is of a similar race or cultural background as them. Due to years of mistreatment from the medical system African-Americans tend not to follow recommendations of their physicians. This review was conducted to explore what can be done to minimize physician-patient race concordance Following are my goals and objectives: GOAL: Contribute knowledge of how race of the physician can affect (both negatively and positively) the health outcome of the patient.
. Describe the historical development and practices used in the United States healthcare system. More specifically, the lack of trust that has been established between white doctors and black patients i.e Tuskegee experiment
. Determine how current medical practices affect different racial groups affect and how this has an impact on their health status and health behaviors
. Apply appropriate research methods to the evaluation of medical services delivered to minorities.
. Relay the importance of identifying, assessing and prioritizing health problems of all individuals.
ABSTRACT
Objectives: This paper will be to assess if there is a difference in helth outcome of the patient (more specifically African-American patients) based on the race of the doctor. describe historical practices that cause African-Americans to distrust the United States healthcare system and examine how medical instructions may be delivered differently based on race.
Background: Daily racial and intergenerational experiences of inequality and discrimination in healthcare have created a cultural mistrust of medical providers for many minority groups. A majority of the doctors in the United States are of European decent therefore may not be able to communicate effectively to their patients who are not of the same origin.
Methods: Through review of scientific articles the researcher was able to understand both sides of the argument. The articles were found through database searches including Google Scholar, PubMed, and Tulane’s library database. Keywords used in the search were “race concordance, physician patient race concordance, race between Doctor and patient”. The researcher found 23 articles that were well infomed and offered great insight on the study. Articles were not included if the researcher only had access to the abstract and the abstract did not provide any detail about the study that was conducted or the conclusion.
Results: The race of the Doctor does affect the health outcome of the patient due to the historical experiences and treatment of minorities, African American and Hispanic patients are less likely to trust the medical system and more likely to perceive having received better medical care if they belonged to the white racial group.
Discussion: The physician-patient relationship is strengthened when patients see themselves as similar to their physicians in personal beliefs, values, and communication. When there is perceived personal similarity, this can lead to higher ratings of trust, satisfaction, and intention to listen to doctors’ recommendations.
Conclusion: There is increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. This is an important research topic because patients’ trust in their health care providers may affect their satisfaction and health outcomes.
BACKGROUND AND SIGNIFIGANCE
As public health professionals we are taught about the social gradient, which states that inequalities in population health status are related to inequalities in social status. This is often based on race. While many factors affect health care equity, disparities based on race are consistently reported in the management of many diseases. For example, blacks receive a lower standard of care than whites when being treated for breast cancer, orthopedic problems, cardiovascular disease, pain, and end of life care among others. Race affects health care delivery and is an independent factor in health care disparities (Nelson & Hackman, 2012). The Institute of Medicine Report Unequal Treatment statedthat racial/ ethnic disparities in health outcome are not entirely explained by differences in access to care, clinical appropriateness, or patient preferences.
Over the past decades the idea of racial concordance has emerged as an important aspect of the patient-physician relationship that may be linked to health care disparities. Concordance can be defined as a similarity, or shared identity, between physician and patient based on a demographic attribute, such as race, sex, or age (Street, O’Malley, Cooper, & Haidet, 2008). Physician-patient race concordance looks at the race of the physician and how that affects the health of the patient. According to Street et. al, 2008 patients’ trust, satisfaction, utilization of services, and involvement in decision making have been reported higher when the patient and physician share the same race or ethnicity. This makes sense because if an individual thinks that he/she have something in common with their provider then he/she are more likely to listen to the provider’s recommendation. In turn he/she are more likely to take better care of themselves which will result in better health outcomes. This is extremely important because the US tends to be at the lower end of health outcomes when compared to other countries. Another reason that having physicians of similar race as their patient is important is because African Americans typically have lower health status compared to their white counterparts, by having a doctor of the same race this could improve African Americans health outcomes. Other studies have found that there are no significant effects of physician-patient racial concordance on patient-physician relationships (citations?). This paper will review literature from both sides of racial concordance and racial discordance to determine its effect on health outcomes.
When patients interact with a physician whom he/she see as similar to themselves he/she may see themselves as less distanced socially. This takes into account the fact that the physician has similar beliefs and values about health care, these individuals will be more inclined to trust that physician. According to Street et. al, 2008 investigating the perceptual underpinnings of concordance effects is important because, although a person’s demographic characteristics are for the most part fixed, perceptions of the physician-patient relationship are modifiable and could be the focus of interventions to improve communication.
The white race is often looked at as “the superior race” regardless of socioeconomic status, while minorities fall into the “inferior race” category. Race is a social and political construction; racial categorization is not based on biological differences between groups but on continually changing and contextual relationships between groups. It is widely documented that unequal treatment stemming from physician uncertainty or bias and linguistic and cultural barriers may negatively influence health outcomes for patients of color (Traylor, Schmittdiel, Uratsu, Mangione, & Subramanian, 2010). Racial/ethnic minorities often rate the quality of care by physicians and within the health care system in general more negatively than Whites, a reason for this could the lower rates of African Americans as doctors. This could also be because white physicians may treat their patients of different races differently than their white patients.
Health disparities in the United States have always been prevalent, however it did not become “popular” until 2011,the United States Centers for Disease Control (CDC) released their first ever report on health disparities and inequalities in 2011, identifying and describing major issues and offering potential solutions, such as working across programs to increase access to economic, educational, employment, and housing opportunities.
METHODS
This topic was selected because it is important to consider all aspects when looking at health outcomes. Since African-Americans tend to be behind other races in all aspects related to health, communication could be one of the simple answers to this problem. Scientific articles (23) were found through database searches including Google Scholar, PubMed, and Tulane’s library database. At first articles that had been published more than ten years ago were eliminated. However it was discovered that few articles were published in the last ten years, so that inclusion criterion was relaxed. Words used in the search included “concordance,” “race-concordance,” “physician-patient race concordance,” “doctor-patient concordance,” and “doctors race.” A few websites were also used to verify statistics that were included in several articles about the percentages and races of doctors.
SUMMARY OF FINDINGS/RESULTS/ANALYSIS OF INTERPRETATION
There is evidence that racial and ethnic minorities tend to receive lower quality of care than non-minorities. It is also shown that minority patients have higher rates of morbidity and mortality from chronic diseases than non-minorities (Egede, 2006). In many studies, the inequality persists even when access factors such as insurance coverage and income are controlled. Race is sometimes used by physicians to gauge the patient’s intelligence, adherence to medical advice, and the relationship towards the patient (Traylor et al., 2010). Several studies suggest that physicians hold more negative perceptions about the likelihood of adherence, engagement in risk behaviors, and social resources available to black patients (Bleich, Simon, & Cooper, 2011). It is often stated that black physicians are more likely to practice in areas with large concentrations of minorities and low-income individuals. Thus, the likelihood of a minority patient seeing a physician of their own race may be higher for minorities of lower socioeconomic status (Komaromy et al., 1996).
Due to the historical experiences and treatment of minorities, African American and Hispanic patients are less likely to trust the medical system and more likely to perceive having received better medical care if he/she belonged to the white racial group. Correspondingly, studies on patient preferences for a same race/ethnicity physician have found that African American and Hispanic patients who have a choice are more likely to choose a same-race physician (Traylor et al., 2010). One study compared patients whose primary physicians were of a different race/ethnicity to patients who were of the same racial/ethnic group as their physicians. Researchers concluded that patients who were of the same racial/ethnic group as their physicians were more likely to use needed health services, less likely to postpone looking for care, and report a higher volume of the use of health services (Traylor et al., 2010). Disparities in health care can emerge from bias (or prejudice) against minorities, greater clinical uncertainty during interactions, and the provider’s beliefs about the health behaviors (Blanton & Lewis, 2005).
On the contrary, some studies show patient and physician race concordance does not affect patient outcomes; patients can still have different outcomes despite racial concordance. A study supporting this claim states that being similar to the physician in terms of race, ethnicity, and community did not always orient patients toward common ground with the physician. Other factors may be more influential determinants of perceived personal similarity such as age, education, and the degree to which physicians are patient-centered in their communication (Street, O’Malley, Cooper & Haidet, 2008).
Patient-centered care for minority patients incorporates treating patients and their families as partners, involving them in planning their health care, and encouraging them to take responsibility for it (Langer & Langer, 2009). Furthermore, patients experience greater satisfaction, trust, and commitment to treatment when a physician is skilled in advising, showing respect, and supporting patient involvement (Street et al., 2008).
A study that focused on lung cancer treatment disparities between Black and White patients suggests that racial differences in patient’s preferences were small, and not large enough to explain the magnitude of racial disparities in health care. They also indicate racial disparities in health care may be derived from problems with doctor-patient communication (Gordon, Street, Sharf & Souchek, 2006). Health communication that is patient-centered can evolve into the singularly most important tool providers have to enhance access and delivery of health care to ethnically diverse populations (Langer & Langer, 2009).
In medical interactions where the doctor and patient were of the same race/ethnicity, patients perceived that they received better care. Patients also perceived doctors being engaged in more participatory decision-making than patients in discordant interactions, possibly due to better communication. Racial disparities in doctor-patient communication may lead to less information exchange, fewer patient involvement in care, and less informed medical decisions. In the study, doctors gave more information to patients who were more active in the consultation. Being active means patients will ask questions, express concerns, and state their preferences; these behaviors shows the patient’s needs and expectations for the doctor to respond (Gordon et al., 2006).
Racial variation in doctor’s information-giving is not uniquely related to race, but to the tendency for patients of one racial group to be less actively involved than patients from another group. Researchers found Black patients in racially discordant consultations received less information overall, because they are less often engaged in communication behaviors that typically prompt more information from doctors. This information includes questions, concerns and assertions, leading to a difference in health outcomes compared to White patients (Gordon et al., 2006). Researchers found a discrepancy in weight-related counseling with information-giving when Black obese patients received less exercise counseling than White obese patients, even when matched with a racially concordant counselor (Bleich, Simon & Cooper, 2011). Concordance is not always an important predictor of outcomes, the relationship between the two still remains unclear (Jerant, Bertakis, Fenton, Tancredi, & Franks, 2011). Increasing patient-provider gender and race/ethnicity concordance has been proposed to improve healthcare and help mitigate health disparities.
Moreover, there are many cases in which white physicians effectively counsel minority patients and provide helpful treatment options. Likewise, not all minority physicians communicate effectively with minority patients. However, the available research points to problems in communication between doctors and minority patients and suggests that stereotypes, unrealistic expectations, and communication gaps are pervasive (Perloff et al., 2006).
One common objection to the concordance theory is that patients may see doctors of their own race because minority doctors tend to be more conveniently located in minority communities. Black doctors tend to be in clinics that provide service to black patients. After reviewing the literature, it seems that patients who are from minority populations tend to prefer physicians of their own race. Since most of the research that I found were before 2010 it is safe to say that more research is needed to examine the reasons for this preference and how it truly plays a role in health outcomes.
DISCUSSION
White individuals do not encounter as much racial discrimination as people of other races in daily life and this is no different in the medical field. This is because white physicians make up 75.0% of the physician workforce. The U.S. physician workforce diversity remains consistentwith prior years with approximately 8.9 percent of physicians identifying as black or African-American, American Indian or Alaska Native, and Hispanic or Latino. However, these percentages do not line up with the nation’s demographic shift towards greater diversity. Although blacks and African-Americans comprise 13 percent of the nation, they account for only 4 percent of the physician workforce (Association of American Medical Colleges [AAMC], 2014). In 2013, out of the total U.S. MD active physicians, 4.1% were Black or African American, 4.4% were Hispanic or Latino, 0.4% were American Indian or Alaska Native, 11.7% were Asian, and 48.9% were White (Association of American Medical Colleges [AAMC], 2014). As seen by these reports there is a large gap between the number of minority doctors practicing and the number needed in order for minority patients to see themselves represented in the medical field.
According to Traylor et al., 2010, African American and Hispanic patients are more likely than White patients to be treated by a physician from a dissimilar racial or ethnic background. This is also evident because patient–physician communication during medical visits differs between African American versus White patients. Physicians were more verbally dominant and tended to be less patient centered in their approach with African American patients than with White patients (Johnson, Roter, Powe, & Cooper, 2004). Only 9.7% of African American patients and 11.2% of Hispanic patients were racially/ethnically matched while nearly 48% of White patients and 63% of Asian patients were racially/ethnicity matched. Hispanic patients who spoke Spanish as a primary language were also more likely to have a same-ethnicity physician (Traylor et al., 2010).
A change that can be made to eradicate the problem of physician patient disconcordance is to incorporate culturally sensitive trainings and practice into health care. If a provider is culturally he/she will consider the patient’s needs and preferences based on his/her cultural beliefs and practices and understand the importance of these factors in the treatment plan (Thom & Tirado, 2006). Another component of competence is the awareness of the effect that racism and the cultural mistrust have on all relationships (Benkert, Peters, Tate, & Dinardo, 2008). When trust is built it can result in the use of recommended preventive services in low-income African-American women and stronger patient–provider relationships. High levels of trust, may lead to better health, because patients will be more willing to listen to their doctors and visit them often.
Another change that can be made is to increase recruitment of underrepresented minorities in medicine. A policy could be created to help increase the pool of underrepresented minority physicians in medical schools. This could be done through better recruiting efforts to get minorities to medical schools, through increase funding a safe and welcoming environment for minority students interested in pursuing a medical degree. With more scholarships minority medical school students would not have to worry about fees they have to pay back or if they will burden their families. Since they will not have to worry about paying back financial aid they may work in fields that they are interested in but does not pay well as others, such as family physicians/general practitioners, this will increase their availability for lower-income populations.
By simply breaking down the perceived barriers such as racial bias, along with better communication, the physician will be able to provide quality care to their patient. The gap between health disparities could be reduced when the physician’s care is alligned with the patient’s values, needs, preferences, trust, and satisfaction. Additionally, the availability of minority physicians needs to be increased to give minority patients the option to choose a same-race physician. Increasing the availability of minority physicians is likely to require targeted outreach programs and race-based recruitment and retention programs, including affirmative action programs.
CONCLUSION
The white race is often looked at as “the superior race” regardless of socioeconomic status, while minorities fall into the “inferior race” category. Race is a social and political construction; racial categorization is not based on biological differences between groups but on continually changing and contextual relationships between groups. White physicians make up 75.0% of the physician workforce. The U.S. physician workforce diversity remains consistentwith prior years with approximately 8.9 percent of physicians identifying as black or African-American, American Indian or Alaska Native, and Hispanic or Latino. However, these percentages do not line up with the nation’s demographic shift towards greater diversity. Due to these disproportionate numbers a lot of minorities have white doctors, this is problematic because research shows that this can affect an individual’s health outcome. When patients interact with a physician whom he/she see as similar to themselves he/she may see themselves as less distanced socially. This takes into account the fact that the physician has similar beliefs and values about health care, these individuals will be more inclined to trust that physician. Doctor-Patient concordance can be solved by having funding for minority med students to go to school, the cost of the education is one less thing they have to worry about and making it mandatory that existing doctors have to attend cultural competency training. If a provider is culturally he/she will consider the patient’s needs and preferences based on his/her cultural beliefs and practices and understand the importance of these factors in the treatment plan (Thom & Tirado, 2006).
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