August 10, 1999
African-American patients rate their doctor visits as significantly "less participatory" than do whites, according to a Johns Hopkins-led study reported in the Aug. 11 issue of the Journal of the American Medical Association.
The study also showed that African-American and white patients rated their visits with same-race physicians as significantly more participatory than with different-race doctors. And patients of female physicians rated their visits as more participatory than patients of male physicians.
In telephone surveys conducted between Nov. 1996 and June 1998, researchers asked 1,816 adults questions about their level of involvement during recent medical visits. Patient satisfaction with their doctors' decision-making styles was assessed by asking the following three questions: "If there were a choice between treatments, how often would this doctor ask you to help make the decision?"; "How often does this doctor give you some control over your treatment?"; and "How often does this doctor ask you to take some of the responsibility for your treatment?" Each physician's style was assigned a numerical score based on patient responses.
"Our study suggests that patients' satisfaction level is highly correlated with how much physicians involve them in the decision-making process," says Lisa Cooper-Patrick, M.D., M.P.H., lead author of the study and an assistant professor of medicine at Hopkins. "Patients who are the same race or ethnicity as their physician may feel more comfortable talking to their physicians and, therefore, have a greater sense of partnership."
To overcome communication barriers and achieve better health outcomes, she says, there is a need for more minority physicians and better cross-cultural communication training not only for primary care physicians but also for nurses, technicians, receptionists and other personnel who come in contact with patients.
"In addition, patients should be advocates for their own health," Cooper-Patrick says. "They should feel free to ask questions, and they should not leave the doctor's office or clinic unless they are comfortable with the decisions made."
All patients surveyed were members of a large managed care organization in an urban setting. Sixty-six percent of patients surveyed were female, 43 percent were white, 45 percent were African-American and 12 percent were either Asian, Latino or Native American. The physician sample was 63 percent male, 56 percent white and 25 percent African-American.
About 60 percent of patients were seeing a male physician and 40 percent were seeing a female physician. More than 40 percent were seeing white physicians, 27 percent were seeing African-American physicians, and 25 percent were seeing physicians of other races.
The study also found that:
- Patients aged 40 to 65 rated their visits as more participatory than patients younger than 30.
- Patients with a graduate school education said they had more participatory visits than those with a high school education or less.
- Patients with better ratings of their own health status said they had more participatory visits.
- Patients who knew their physician for three years or longer rated their visits as more participatory than patients who knew their physician for less than one year.
During the next phase of this study, Cooper-Patrick says, investigators will place audiotape machines in doctors' offices during medical visits to better assess doctor-patient communication.
The study was supported in part by the Bayer Institute for Health Care Communication, the Robert Wood Johnson Foundation Minority Medical Faculty Development Program and the National Institute of Mental Health.
The study's other authors were Joseph J. Gallo, M.D., M.P.H.; Hong Thi Vu, M.H.S.; Neil R. Powe, M.D., M.P.H.; and Daniel E. Ford, M.D., M.P.H., of Hopkins; Junius J. Gonzales, M.D., of Georgetown University Medical Center, Washington, D.C.; and Christine Nelson, R.N., of NYLCare Health Plans of the Mid-Atlantic, Greenbelt, Md.