The trust gap for minority patients
CHICAGO — New research confirms that many Hispanics, blacks and other minorities perceive that doctors just don’t care about them and that their medical care isn’t as good as it could be.
According to University of Pennsylvania research fellow Abigail Sewell, compared with whites, Latinos and blacks are less likely to trust the technical judgment and interpersonal competence of doctors. Latinos are also less likely to trust the fiduciary ethic of their physicians. And the differences between black and Hispanic levels of trust have to do with whether a patient’s parents are U.S.-born or not.
“Most people who are immigrants or have some immigrant connection feel more disenfranchised from the health care system,” Sewell said in a University of Pennsylvania press release announcing her study, which was published in the November issue of the journal Social Science Research.
Though her paper notes that past research has produced mixed evidence about whether minorities trust physicians less than whites, Sewell used 2002 and 2006 General Social Surveys to ascertain that not only is there lower trust, but that these findings are not easy to uncover due to the way physician evaluation methods assess a patient’s confidence in a doctor.
Specifically, Sewell found that respondents believed that their doctors don’t take the challenges of their personal lives — such as their access to transportation and safe spaces for exercise or other factors, like legal status — into consideration.
The idea that minorities don’t feel respected when they seek health care is being studied more, which is yielding a clear body of research that shows these perceptions are widespread.
Studies going back over a decade have found that women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively.
New research based on nationwide data from the Centers for Disease Control and Prevention found that non-Hispanic blacks and other minorities are 22 percent to 30 percent less likely to receive pain medication during an emergency room visit, relative to non-Hispanic whites.
And just in case you’re thinking this is a problem that only affects non-whites, think again. This same study, which was published in the journal Medical Care, found that some white patients were also less likely to get pain medication if they were treated at a hospital with high concentrations of minority patients.
With only about 8.9 percent of U.S. physicians identifying as black, American Indian, Alaska Native or Hispanic, the most pressing need is for the cultivation and training of more minority physicians. But not far behind is the necessity of educating seasoned doctors to be more understanding of the cultural differences between themselves and their increasingly diverse patients.
And these measures are only part of the equation.
“This problem needs to be addressed through both providers and patients,” said Jose Ortiz, president and CEO of the Hispanic Health Council, a Hartford, Connecticut-based organization that creates bilingual, culturally tailored programs to eliminate health disparities in the Latino community. “We work with providers through participatory training that builds a foundation of knowledge, attitudes and skills needed to work effectively with diverse populations. The training explores issues of health inequity, stereotyping and unequal dynamics of power between providers and patients, and builds concrete skills toward addressing them.
“But we also work with patients through community health worker service programs, and it is clear that a number of factors must be overcome — these include histories of oppression of various types, lack of health and health care literacy, some cultural factors, among others. This requires an intensive educational and empowerment process that allows health care consumers to learn their rights and gain the practice and confidence needed to act upon them.”
You can imagine these “intensive” processes aren’t cheap, but they can be effective not only for minority communities, but also for underinsured, low-income whites and elderly patients who might be intimidated by the preponderance of high-tech gadgetry and more diverse caregivers in routine medical care.
But first we have to start with this: The disconnect between white physicians and their minority patients is becoming a legitimately documented phenomenon, not just one of those all-in-your-head things.
Once the medical establishment and patients of all races can internalize this, we can really start addressing it.
Esther Cepeda’s email address is firstname.lastname@example.org. Follow her on Twitter, @estherjcepeda.
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