Is Primary Care Providers’ Trust in Socially Marginalized Patients Affected by Race?
Interpersonal trust plays an important role in the clinic visit. Clinician trust in the patient may be especially important when prescribing opioid analgesics because of concerns about misuse. Previous studies have found that non-white patients are perceived negatively by clinicians.
To examine whether clinicians’ trust in patients differed by patients’ race/ethnicity in a socially marginalized cohort.
Cross-sectional study of patient-clinician dyads.
169 HIV infected indigent patients recruited from the community and their 61 primary care providers (PCPs.)
The Physician Trust in Patients Scale (PTPS), a validated scale that measures PCPs’ trust in patients.
The mean PTPS score was 43.2 (SD 10.8) out of a possible 60. Reported current illicit drug use and prescription opioid misuse were similar across patients’ race or ethnicity. However, both patient illicit drug use and patient non-white race/ethnicity were associated with lower PTPS scores. In a multivariate model, non-white race/ethnicity was independently associated with PTPS scores 6.3 points lower than whites (95% CI: −9.9, −2.7). Current illicit drug use was associated with PTSP scores 5.5 lower than no drug use (95% CI −8.5, −2.5).
In a socially marginalized cohort, non-white patients were trusted less than white patients by their PCPs, despite similar rates of illicit drug use and opioid analgesic misuse. The effect was independent of illicit drug use. This finding may reflect unconscious stereotypes by PCPs and may underlie disparities in chronic pain management.
- Thom DH, Campbell B. Patient-physician trust: an exploratory study. J Fam Pract. Feb 1997;44(2):169–76.
- Grimen H. Power, trust, and risk: some reflections on an absent issue. Med Anthropol Q. Mar 2009;23(1):16–33. CrossRef
- Thom DH, Hall MA, Pawlson LG. Measuring patients' trust in physicians when assessing quality of care. Health Aff (Millwood). Jul-Aug 2004;23(4):124–32. CrossRef
- Mechanic D. The functions and limitations of trust in the provision of medical care. J Health Polit Policy Law. Aug 1998;23(4):661–86.
- Hall MA, Zheng B, Dugan E, et al. Measuring patients' trust in their primary care providers. Med Care Res Rev. Sep 2002;59(3):293–318. CrossRef
- Scanlon MN, Chugh U. Exploring physicians' comfort level with opioids for chronic noncancer pain. Pain Res Manag. Winter 2004;9(4):195–201.
- Merrill JO, Rhodes LA, Deyo RA, Marlatt GA, Bradley KA. Mutual mistrust in the medical care of drug users: the keys to the "narc" cabinet. J Gen Intern Med. May 2002;17(5):327–33.
- Breitbart W, Kaim M, Rosenfeld B. Clinicians' perceptions of barriers to pain management in AIDS. J Pain Symptom Manage. Sep 1999;18(3):203–12. CrossRef
- Berg KM, Arnsten JH, Sacajiu G, Karasz A. Providers' experiences treating chronic pain among opioid-dependent drug users. J Gen Intern Med. Apr 2009;24(4):482–8. CrossRef
- Ives TJ, Chelminski PR, Hammett-Stabler CA, et al. Predictors of opioid misuse in patients with chronic pain: a prospective cohort study. BMC Health Serv Res. 2006;6:46. CrossRef
- Edlund MJ, Steffick D, Hudson T, Harris KM, Sullivan M. Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain. Jun 2007;129(3):355–62. CrossRef
- Chabal C, Erjavec MK, Jacobson L, Mariano A, Chaney E. Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors. Clin J Pain. Jun 1997;13(2):150–5. CrossRef
- Green CR, Anderson KO, Baker TA, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. Sep 2003;4(3):277–94. CrossRef
- Burgess DJ, Crowley-Matoka M, Phelan S, et al. Patient race and physicians' decisions to prescribe opioids for chronic low back pain. Soc Sci Med. Dec 2008;67(11):1852–60. CrossRef
- Mills AM, Shofer FS, Boulis AK, Holena DN, Abbuhl SB. Racial disparity in analgesic treatment for ED patients with abdominal or back pain. Am J Emerg Med. Apr 30 2010.
- Green CR, Wheeler JR, Marchant B, LaPorte F, Guerrero E. Analysis of the physician variable in pain management. Pain Med. Dec 2001;2(4):317–27. CrossRef
- Crowley-Matoka M. Political and moral economies of managing pain. American Anthropological Association annual meeting. Washington, DC; 2005.
- Henderson S, Stacey CL, Dohan D. Social stigma and the dilemmas of providing care to substance users in a safety-net emergency department. J Health Care Poor Underserved. 2008 Nov 2008;19(4):1336–49. CrossRef
- Stepanikova I, Cook, KS, Thom, DH, Kramer, RM, Mollborn, SB. Trust in Managed Care Settings: Physicians’ Perspective. In: Karen S. Cook KS LM, Hardin R, ed. Who Can We Trust?: How Groups, Networks, and Institutions Make Trust Possible. Thousand Oaks, CA: Rusell Sage Foundation; 2009.
- van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians' perceptions of patients. Soc Sci Med. Mar 2000;50(6):813–28. CrossRef
- Robertson MJ, Clark RA, Charlebois ED, et al. HIV seroprevalence among homeless and marginally housed adults in San Francisco. Am J Public Health. Jul 2004;94(7):1207–17. CrossRef
- Zolopa AR, Hahn JA, Gorter R, et al. HIV and tuberculosis infection in San Francisco's homeless adults. Prevalence and risk factors in a representative sample. Jama. Aug 10 1994;272(6):455–61. CrossRef
- Horton J, Compton, W, Cottler, L. Assessing Psychiatric Disorders Among Drug Users: Reliability of The Revised DIS-IV. In: Harris L, ed. NIDA Research Monograph-Problems of Drug Dependence. Washington, D.C: NIH; 1998.
- Williams ML, Freeman RC, Bowen AM, et al. A comparison of the reliability of self-reported drug use and sexual behaviors using computer-assisted versus face-to-face interviewing. AIDS Educ Prev. Jun 2000;12(3):199–213.
- Thom DH WS, Guzman D, Wu A, Penko J, Miaskowski C, Kushel M. Physician Trust in the Patient: Development and Validation of a New Measure. Ann Fam Med. in press.
- Horton J CW, Cottler L. Assessing Psychiatric Disorders Among Drug Users: Reliability of The Revised DIS-IV. Washington DC: National Institutes of Health; 1998.
- Nicholson B, Passik SD. Management of chronic noncancer pain in the primary care setting. South Med J. Oct 2007;100(10):1028–36. CrossRef
- Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. Mar 1986;42(1):121–30. CrossRef
- Liang K-Y, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73(1):13–22. CrossRef
- Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. Sep 2007;22(9):1231–8. CrossRef
- Chen M, Bargh, JA. Nonconscious behavioral confirmation processes: The self-fulfilling consequences of automatic stereotype activation. J Exp Soc Psychol. 1997;35(5):541–60. CrossRef
- Devine P. Stereotypes and prejudice: Their automatic and controlled components. J Pers Soc Psychol. 1989;56(1):5–18. CrossRef
- Wittenbrink B, Judd, C M, Park, B. Evidence for racial prejudice at the implicit level and its relationship with questionnaire measures. J Pers Soc Psychol 1997;72(2):262–74. CrossRef
- van Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. Jan 2002;40(1 Suppl):I140-151.
- Burgess DJ, van Ryn M, Crowley-Matoka M, Malat J. Understanding the provider contribution to race/ethnicity disparities in pain treatment: insights from dual process models of stereotyping. Pain Med. Mar-Apr 2006;7(2):119–34. CrossRef
- Burgess DJ. Are providers more likely to contribute to healthcare disparities under high levels of cognitive load? How features of the healthcare setting may lead to biases in medical decision making. Med Decis Making. Mar-Apr 2010;30(2):246–57. CrossRef
- Chen I, Kurz J, Pasanen M, et al. Racial differences in opioid use for chronic nonmalignant pain. J Gen Intern Med. 2005 Jul 2005;20(7):593–8. CrossRef
- Dimsdale JE. Stalked by the past: the influence of ethnicity on health. Psychosom Med. Mar-Apr 2000;62(2):161–70.
- Ng B, Dimsdale JE, Rollnik JD, Shapiro H. The effect of ethnicity on prescriptions for patient-controlled analgesia for post-operative pain. Pain. Jul 1996;66(1):9–12. CrossRef
- Godin P. Trust built on shared power. Nurs Stand. Nov 26-Dec 2 2008;23(12):62–3.
- Thom DH, Ribisl KM, Stewart AL, Luke DA. Further validation and reliability testing of the Trust in Physician Scale. The Stanford Trust Study Physicians. Med Care. May 1999;37(5):510–7. CrossRef
- Mead N, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. Oct 2000;51(7):1087–110. CrossRef
- Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med. Feb 2000;15(2):122–8. CrossRef
- Sabin J, Nosek BA, Greenwald A, Rivara FP. Physicians' implicit and explicit attitudes about race by MD race, ethnicity, and gender. J Health Care Poor Underserved. Aug 2009;20(3):896–913. CrossRef
- Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. May 10 1999;159(9):997–1004.
- Starrels JL, Becker WC, Alford DP, Kapoor A, Williams AR, Turner BJ. Systematic review: treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain. Ann Intern Med. Jun 1 2010;152(11):712–20.
- Is Primary Care Providers’ Trust in Socially Marginalized Patients Affected by Race?
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Journal of General Internal Medicine
Volume 26, Issue 8 , pp 846-851
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- vulnerable populations
- opioid analgesics
- Industry Sectors
- Author Affiliations
- 1. Division of General Internal Medicine, University of California San Francisco/San Francisco General Hospital, 3333 California Street, Room 383, 1211, San Francisco, CA, 94143 – 1211, USA
- 2. Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, USA
- 3. Department of Physiological Nursing, University of California San Francisco, San Francisco, CA, USA