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Blacks and Latinos are hospitalized and undergo surgery or other invasive procedures that require a doctor's order at lower rates than white patients, even when their access to care, diagnosis, and illness severity are the same. This suggests that disparities in health care use emerge after the patient gets to the doctor, in the context of the doctor-patient interaction, not from difficulties in getting to the doctor in the first place. Poor communication between doctors and minority patients may be one source of racial disparities in the use of health services, according to the findings from a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS10876).
Texas researchers led by Carol Ashton, M.D., M.P.H., of the Baylor College of Medicine, and her colleagues point to evidence indicating that racial and ethnic disparities in health care and health outcomes are not due solely to either racial bias on the part of doctors or patient preferences. Communication is important. Patients from different ethnic groups may be more or less inclined to provide a health narrative (how they view their condition and its cause) to the doctor, may use different terms to describe the same phenomenon, and may screen out views that they think the doctor will find unacceptable (for example, non-Western beliefs about illness). Also, ethnic and cultural norms influence a patients' willingness to ask questions, express concerns, and be assertive during a medical interaction.
Patients who ask more questions and express more concerns receive more information from doctors who, in turn, perceive them as better communicators. These researchers suggest that during each patient encounter doctors should provide openings and prompts to help the patient do four things: provide a health narrative, ask questions, express concerns, and be assertive. Providing patients with pocket cards and waiting room videotapes on "how to talk with your doctor" also may be useful.
More details are in "Racial and ethnic disparities in the use of health services," by Dr. Ashton, Paul Haidet, M.D., M.P.H., Debora A. Paterniti, Ph.D., and others, in the February 2003 Journal of General Internal Medicine 18, pp. 146-152.
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