Racial attitudes, physician-patient talk time ratio, and adherence in racially discordant medical interactions
Racial attitudes, physician-patient talk time ratio, and adherence in racially discordant medical interactions
复制标题
DOI：
10.1016/j.socscimed.2013.03.016
复制
发表时间：
2013-06-01
影响因子：
5.4
通讯作者：
Albrecht, Terrance L.
中科院分区：
文献类型：
--
作者：
Hagiwara, Nao;Penner, Louis A.;Albrecht, Terrance L.
医生的种族偏见和患者感知的歧视都被发现影响了对种族不和谐的医疗互动的看法和感受。然而，据我们所知，还没有研究研究它们如何同时影响这些相互作用的动态。本研究考察了(A)非黑人初级保健医生的显性和隐性种族偏见和(B)黑人患者感知的过去歧视如何影响医疗互动中的医患交谈时间比率(即医生与患者交谈时间的比率)，以及这一比率与患者随后的依从性之间的关系。我们对2006年6月至2008年2月期间美国中西部一家初级保健诊所的112名低收入黑人患者和他们的14名非黑人医生之间的临床互动进行了二次分析，这些数据来自先前的一项研究的自我报告和视频记录数据。总体而言，医生比患者交谈更多；然而，医生偏见和患者对过去歧视的感知都影响了医生与患者交谈的时间比率。内隐但非外显种族偏见水平较高的非黑人医生与内隐偏见水平较低的医生相比，医生与患者的交谈时间比率更大，这表明拥有更多负面种族态度的医生比具有较少负面种族态度的医生谈论得更多。此外，感觉到歧视程度较高的黑人患者的医患交谈时间比率较小，这表明具有较多负面种族态度的患者比具有较少负面种族态度的患者交谈更多。最后，较小的医生与患者交谈时间比率与患者随后的依从性较低相关，这表明在种族不和谐的医疗互动中交谈较多的患者随后坚持的可能性较小。这些发现的理论和实践意义是在影响种族不和谐的医学互动的动态的因素的背景下讨论的。(C)2013爱思唯尔有限公司。保留所有权利。
Physician racial bias and patient perceived discrimination have each been found to influence perceptions of and feelings about racially discordant medical interactions. However, to our knowledge, no studies have examined how they may simultaneously influence the dynamics of these interactions. This study examined how (a) non-Black primary care physicians' explicit and implicit racial bias and (b) Black patients' perceived past discrimination affected physician-patient talk time ratio (i.e., the ratio of physician to patient talk time) during medical interactions and the relationship between this ratio and patients' subsequent adherence. We conducted a secondary analysis of self-report and video-recorded data from a prior study of clinical interactions between 112 low-income, Black patients and their 14 non-Black physicians at a primary care clinic in the Midwestern United States between June, 2006 and February, 2008. Overall, physicians talked more than patients; however, both physician bias and patient perceived past discrimination affected physician-patient talk time ratio. Non-Black physicians with higher levels of implicit, but not explicit, racial bias had larger physician-patient talk time ratios than did physicians with lower levels of implicit bias, indicating that physicians with more negative implicit racial attitudes talked more than physicians with less negative racial attitudes. Additionally, Black patients with higher levels of perceived discrimination had smaller physician-patient talk time ratios, indicating that patients with more negative racial attitudes talked more than patients with less negative racial attitudes. Finally, smaller physician-patient talk time ratios were associated with less patient subsequent adherence, indicating that patients who talked more during the racially discordant medical interactions were less likely to adhere subsequently. Theoretical and practical implications of these findings are discussed in the context of factors that affect the dynamics of racially discordant medical interactions. (C) 2013 Elsevier Ltd. All rights reserved.