Influence of Patient Race on Physician Prescribing Decisions: A Randomized On-Line Experiment

  • Saif S. Rathore
  • Jonathan D. Ketcham
  • G. Caleb Alexander
  • Andrew J. Epstein
Original Article



Prior research reports black patients have lower medication use for hypercholesterolemia, hypertension, and diabetes.


To assess whether patient race influences physicians’ prescribing.


Web-based survey including three clinical vignettes (hypercholesterolemia, hypertension, diabetes), with patient race (black, white) randomized across vignettes.


A total of 716 respondents from 5,141 eligible sampled primary care physicians (14% response rate).




Medication recommendation (any medication vs none, on-patent branded vs generic, and therapeutic class) and physicians’ treatment adherence forecast (10-point Likert scale, 1—definitely not adhere, 10—definitely adhere).


Respondents randomized to view black patients (n = 371) and white patients (n = 345) recommend any medications at comparable rates for hypercholesterolemia (100.0% white vs 99.5% black, P = 0.50), hypertension (99.7% white vs 99.5% black, P = 1.00), and diabetes (99.7% white vs 99.7% black, P = 1.00). Patient race influenced medication class chosen in the hypertension vignette; respondents randomized to view black patients recommended calcium channel blockers more often (20.8% black vs 3.2% white) and angiotensin-converting enzyme inhibitors less often (47.4% black vs 62.6% white) (P < 0.001). Patient race did not influence medication class for hypercholesterolemia or diabetes. Respondents randomized to view black patients reported lower forecasted patient adherence for hypertension (P < 0.001, mean: 7.3 black vs 7.7 white) and diabetes (P = 0.05 mean: 7.4 black vs 7.6 white), but race had no meaningful influence on forecasted adherence for hypercholesterolemia (P = 0.15, mean: 7.2 black vs 7.3 white).


Racial differences in outpatient prescribing patterns for hypertension, hypercholesterolemia, and diabetes are likely attributable to factors other than prescribing decisions based on patient race.


patient race prescription medication hypertension hypercholesterolemia diabetes 



Harris Interactive implemented the survey and participated in its design. Survey costs and the authors’ time were funded by Pfizer Inc. The authors performed this analysis independently of the funder and retained full control of all aspects of the analysis, including survey design, data analysis and interpretation, preparation of the manuscript, and submission decisions.

Dr. Alexander has career development awards from the Agency for Healthcare Research and Quality (K08 HS15699-01A1) and the Robert Wood Johnson Physician Faculty Scholars Program.

The funding sources had no role in the design and conduct of the study, analysis or interpretation of the data; and preparation or final approval of the manuscript prior to publication.

The authors have no conflicts of interest to report.


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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Saif S. Rathore
    • 1
  • Jonathan D. Ketcham
    • 2
  • G. Caleb Alexander
    • 3
    • 4
    • 5
    • 6
  • Andrew J. Epstein
    • 7
    • 8
  1. 1.MD/PhD Program, SHM IE-61Yale University School of MedicineNew HavenUSA
  2. 2.W.P. Carey School of BusinessArizona State UniversityTempeUSA
  3. 3.Center for Health and Social SciencesUniversity of ChicagoChicagoUSA
  4. 4.General Internal Medicine Section, Department of MedicineUniversity of ChicagoChicagoUSA
  5. 5.MacLean Center for Clinical Medical EthicsUniversity of ChicagoChicagoUSA
  6. 6.Department of Pharmacy PracticeUniversity of Illinois at Chicago School of PharmacyChicagoUSA
  7. 7.Section of Health Policy and Administration, Department of Epidemiology and Public HealthYale University School of MedicineNew HavenUSA
  8. 8.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA

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