Lower quality patient-physician relationships are attributed to differences in physicians' cultural sensitivity and patients' health care literacy.
"Many studies have shown that patients' race and ethnicity impact the quality of their health care experience. For example, blacks and Hispanics consistently receive lower-quality care. And although some disparities in quality can be attributed to a lack of insurance coverage or access to care, others exist that have nothing to do with financial barriers," said Saha, assistant professor of medical informatics and clinical epidemiology in the OHSU School of Medicine and the Portland Veterans Affairs Medical Center. "This study further explored the degree to which these unknown disparities could be explained by patient-physician interactions, physicians' cultural sensitivity and physicians' race or ethnicity."
Saha, along with colleagues at Johns Hopkins University, analyzed data from a random telephone survey of nearly 6,300 Americans: 1,037 black, 1,153 Hispanic, 621 Asian and 3,488 Caucasian. The survey included questions about respondents' usual source of care, use of basic health services, interactions with physicians, demographics and health status. Sample questions included: Does your doctor listen to everything you say? Did you understand everything the doctor said? Did the doctor involve you in decisions about your care? Did the doctor spend as much time with you as you'd like?
Surprisingly, and contrary to previous research, the study found differences in patient-physician relationships did not account for racial differences in patients' use of health care services. Blacks received more services, and Hispanics and Asians fewer services, than did Whites. Saha suggested the simple, noninvasive nature of the services described in this survey might explain why the patient-physician relationship did not appear to influence use of health care services. Had the services been surgical or invasive interventions for which trust and effective communication played a larger role in the decision-making process, patient-physician relationships might have been of greater importance, he explained.
According to the study, Asian and Hispanic respondents were the least satisfied with the overall quality of their patient-physician relationships and reported the lowest levels of cultural sensitivity from their physicians. They also were less likely to receive recommended preventive care such as cancer screenings and checkups. The researchers report that differences in satisfaction were most likely due to lower quality communication between patients and physicians, and patients' lack of understanding of health care terminology and procedures.
Respect from their physician was the strongest predictor of overall health care satisfaction among blacks, Caucasians and Asians, whereas, spending adequate time with the physician was the primary predictor of satisfaction among Hispanics.
"Further research is needed to fully explain how patient-physician relationships contribute to disparities in health care," said Saha, who is also an assistant professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine. "In the meantime, efforts to improve cross-cultural patient-physician interactions, not just the mastery of facts about different ethnic groups, but patient-centered approaches that include improved interpersonal skills and cultural sensitivity, should be undertaken. Without such efforts, the goal of providing all Americans equitable access to health care will be difficult to achieve."
The study was funded by a Research Career Development award from the Health Services Research and Development Service of the Department of Veterans Affairs, and the Commonwealth Fund, a New York City-based private, independent foundation, which conducted the Health Care Quality Survey.
For more information on Saha and his research, visit