Many studies have documented race and gender differences in health care received by
patients. However, few studies have related differences in the quality of interpersonal
care to patient and physician race and gender.
To describe how the race/ethnicity and gender of patients and physicians are associated
with physicians' participatory decision-making (PDM) styles.
Telephone survey conducted between November 1996 and June 1998 of 1816 adults aged
18 to 65 years (mean age, 41 years) who had recently attended 1 of 32 primary care
practices associated with a large mixed-model managed care organization in an urban
setting. Sixty-six percent of patients surveyed were female, 43% were white, and 45%
were African American. The physician sample (n = 64) was 63% male, with 56% white,
and 25% African American.
Patients' ratings of their physicians' PDM style on a 100-point scale.
African American patients rated their visits as significantly less participatory than
whites in models adjusting for patient age, gender, education, marital status, health
status, and length of the patient-physician relationship (mean [SE] PDM score, 58.0
[1.2] vs 60.6 [3.3]; P = .03). Ratings of minority and white physicians did not differ
with respect to PDM style (adjusted mean [SE] PDM score for African Americans, 59.2
[1.7] vs whites, 61.7 [3.1]; P = .13). Patients in race-concordant relationships with
their physicians rated their visits as significantly more participatory than patients
in race-discordant relationships (difference [SE], 2.6 [1.1]; P = .02). Patients of
female physicians had more participatory visits (adjusted mean [SE] PDM score for
female, 62.4 [1.3] vs male, 59.5 [3.1]; P = .03), but gender concordance between physicians
and patients was not significantly related to PDM score (unadjusted mean [SE] PDM
score, 76.0 [1.0] for concordant vs 74.5 [0.9] for discordant; P = .12). Patient satisfaction
was highly associated with PDM score within all race/ethnicity groups.
Our data suggest that African American patients rate their visits with physicians
as less participatory than whites. However, patients seeing physicians of their own
race rate their physicians' decision-making styles as more participatory. Improving
cross-cultural communication between primary care physicians and patients and providing
patients with access to a diverse group of physicians may lead to more patient involvement
in care, higher levels of patient satisfaction, and better health outcomes.