Profession

Patients say best doctors are ones who look like them

Maybe it's bias. Or maybe it's comfort. A new study says patients are more likely to prefer and recommend a physician of the same race.

By Damon Adams — Posted Jan. 12, 2004

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If you're black or white, patients who share your race will leave your office feeling more satisfied with the encounter.

You also will likely spend an average of two minutes longer with same-race patients, who will rate you as more participatory than physicians of another race.

Johns Hopkins researchers made these conclusions after examining the visits of black and white patients to black and white physicians in the Baltimore and Washington, D.C., areas. Their report appeared in the Dec. 2, 2003, Annals of Internal Medicine.

Health experts said the new study highlights the difference that race can make in health care experiences. The findings come at a time when health leaders are working to reduce racial disparities in health care and provide better health outcomes for minorities.

"There's a comfort level with your own that we have to acknowledge exists in our segregated society," said Somnath Saha, MD, an expert on racial disparities and assistant professor of medicine at the Oregon Health & Science University School of Medicine in Portland, Ore. "Physicians need to be aware, frankly, that race matters for some patients, and the way that they interact with patients probably does contribute to racial disparities in health care quality."

Various reports have drawn attention to the issue.

A 2001 study found that black and Hispanic physicians were more likely than white doctors to have trouble getting patients admitted to hospitals and referred to specialists. A 2002 Institute of Medicine report said racial and ethnic minorities received lower quality care than whites and that some evidence suggests that bias and stereotyping by health professionals may contribute to differences in care.

Last year, a University of Cincinnati study found that black patients who experienced unfair treatment from a physician or nurse, or whose family did, were more likely to prefer black health care professionals. And a public opinion poll co-sponsored by the Harvard Forums on Health said reasons for unequal treatment cited by Americans include culture and language barriers and discrimination by health professionals.

Physician attitudes may play a role

In the Dec. 2 Annals of Internal Medicine report, Johns Hopkins researchers analyzed audiotape visits and surveys of 252 patients (142 blacks and 110 whites) who saw 31 physicians (18 blacks and 13 whites) at 16 primary care clinics from 1998 to 1999.

Patients with same-race doctors were more satisfied with the visit, said their physicians were more participatory and were more likely to recommend the physician to a friend.

The study said patient-centered communication did not explain the favorable ratings for same-race patients. Patient and physician attitudes and expectations were more likely to affect patients' experiences.

"We don't know if it's bias or mistrust or lack of comfort. Certainly, those things are potential reasons," said Lisa Cooper, MD, MPH, lead study author and associate professor of medicine, health policy and management at Johns Hopkins University in Baltimore.

Increasing the number of minority physicians would improve health care experiences for minority patients, said the study, "Patient-Centered Communication, Ratings of Care, and Concordance of Patient and Physician Race." Some health leaders point to "cultural competence" as another remedy, one touted by some medical groups as a way to sensitize doctors to the needs of other racial and ethnic groups.

"Cultural competency should be one of our core competencies in medical school, right up there with taking blood, reading an ECG and taking a thorough patient history," said Anne C. Beal, MD, senior program officer for quality of care for underserved populations at the New York-based Commonwealth Fund, a private foundation that supports health research.

Physicians should examine their own attitudes and make an extra effort to learn more about patients with different backgrounds, doctors said.

"It's imperative that physicians who are not part of a minority community be actively involved in trying to better communicate with patients," said Willarda V. Edwards, MD, a Baltimore internist and board chair of the National Medical Assn., which represents black physicians.

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