Social distance in the clinical encounter: Interactional and sociodemographic foundations for mistrust in physicians
Social distance in the clinical encounter: Interactional and sociodemographic foundations for mistrust in physicians
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DOI：
10.1177/019027250406700301
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发表时间：
2004-09-01
影响因子：
2.7
通讯作者：
Schnittker, J
中科院分区：
文献类型：
--
作者：
Schnittker, J
虽然许多观察员提请注意少数种族/族裔成员和社会经济地位较低的人对医生的信任程度较低，但这种不信任的原因尚不清楚。使用社会距离的角度来看，一个大的，具有全国代表性的数据集，我发现，黑人和西班牙裔是不信任他们的私人医生比白人和教育和收入都增加医生的信任。这些差异中的一小部分可以用医生的行为来解释（上次检查的彻底性，医生听得多好，医生解释得多好），但是在医生的行为保持不变之后，每种差异中的大部分仍然存在。医生行为的其他积极的、强烈的影响只能有限地解释这些差异，因为社会距离缓和了这种行为的影响强度。对于黑人、西班牙裔和社会经济地位较低的人来说，医生行为对信任的影响要比白人和社会经济地位较高的人小得多。社会距离的观点有助于解释这种权重下降，以及不同的社会人口群体评价医生的不同方式。通过将信任的推断理解为一个社会认知过程，学者们可以更清楚地理解为什么某些群体比其他群体更容易接受医生，以及为什么某些群体的不信任更抗拒更新。
Although many observers have drawn attention to the low levels of trust in physicians among members of racial/ethnic minorities and those of lower socioeconomic status, the reasons for this mistrust are not well understood. Using a social distance perspective and a large, nationally representative data set, I find that blacks and Hispanics are less trusting of their personal physicians than are whites and that education and income both increase physician trust. A fraction of each of these differences can be explained by physicians' behavior (the perceived thoroughness of the last examination, how well the physician listened, and how well the physician explained), but most of each difference remains well after physicians' behavior is held constant. The otherwise positive, strong effect of physicians' behavior has only a limited capacity to explain these differences because social distance moderates the strength of the effect of that behavior For blacks, Hispanics, and those of lower socioeconomic status, physicians' behavior exerts much less effect on trust than for whites and those of higher socioeconomic status. A social distance perspective helps to explain this downweighting, as well as the divergent ways in which different sociodemographic groups evaluate physicians. By understanding the inference of trust as a social cognitive process, scholars can understand more clearly why some groups are more receptive to physicians than others, and why some groups' mistrust is more resistant to updating.