Journal of General Internal Medicine

, Volume 24, Issue 4, pp 495–498 | Cite as

Physician Cultural Competence and Patient Ratings of the Patient-Physician Relationship

  • Kathryn A. PaezEmail author
  • Jerilyn K. Allen
  • Mary Catherine Beach
  • Kathryn A. Carson
  • Lisa A. Cooper
Original Article



To determine the association of patients’ ratings of the patient-physician relationship with physicians’ self-reported cultural competence (CC).


Physicians completed a survey assessing their CC in three domains: motivation to learn about other cultures (motivation attitudes), awareness of white privilege and acceptance of a racial group’s choice to retain distinct customs and values (power assimilation attitudes), and clinical behaviors reflective of CC. Their African-American and white patients completed interviews assessing satisfaction with the medical visit, trust in their physician, perceptions of their physician’s respect for them and their participation in care. We conducted regression analyses to explore the associations between CC and patient ratings of the relationship.


Patients of physicians reporting more motivation to learn about other cultures were more satisfied (OR = 2.1, 95% CI = 1.0–4.4), perceived their physicians were more facilitative (β = 0.4, p = 0.02) and reported seeking and sharing more information during the medical visit (β = 0.2, p = 0.03). Physicians’ power assimilation attitudes were associated with patients’ ratings of physician facilitation (β = 0.4, p = 0.02). Patients of physicians reporting more frequent CC behaviors were more satisfied (OR = 3.1, 95% CI = 1.4–6.9) and reported seeking and sharing more information (β = 0.3, p = 0.04).


Attitudinal and behavioral components of CC are important to developing higher quality, participative relationships between patients and their physicians.


cultural competence primary care physician disparities interpersonal relationship quality patient participation 



Financial support for this study was provided by grants from the National Heart, Lung, and Blood Institute (nos. R01HL069403 and K24HL083113) and the National Institute of Nursing Research (FR31NR09889-01 and T32NR07968).

Conflict of Interest

None disclosed.


  1. 1.
    Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19:101–10.PubMedCrossRefGoogle Scholar
  2. 2.
    Cooper LA, Beach MC, Johnson RL, Inui TS. Delving below the surface. Understanding how race and ethnicity influence relationships in health care. J Gen Intern Med. 2006;21:S21–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Taira DA, Safran DG, Seto TB,et al. Do patient assessments of primary care differ by patient ethnicity? Health Serv Res. 2001;36:1059–71.PubMedGoogle Scholar
  4. 4.
    Doescher MP, Saver BG, Franks P, Fiscella K. Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med. 2000;9:1156–63.PubMedCrossRefGoogle Scholar
  5. 5.
    Collins KS, Hughes DL, Doty MM, Ives BL, Edwards JN, Tenney K. Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans. The Commonwealth Fund. 2002.Google Scholar
  6. 6.
    Cooper-Patrick L, Gallo JJ, Gonzales JJ,et al. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;282:583–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Crow R, Gage H, Hampson S, et al. The measurement of satisfaction with healthcare: Implications for practice from a systematic review of the literature. Health Technol Assess. 2002;6.Google Scholar
  8. 8.
    Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47:213–20.PubMedGoogle Scholar
  9. 9.
    Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academies Press;2003.Google Scholar
  10. 10.
    Cooper LA, Roter DL. Patient-provider communication: The effect of race and ethnicity on process and outcomes. In: Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academies Press; 2003.Google Scholar
  11. 11.
    Cooper LA, Roter DL, Bone LR, Larson SM, Miller ER, Barr MS, Carson KA, Levine DM. A randomized controlled trial of interventions to enhance patient-physician partnership, patient adherence and high blood pressure control among ethnic minorities and poor persons: Study Protocol NCT00123045. Implement Sci. 2009; in press.Google Scholar
  12. 12.
    Paez KA, Allen JK, Carson KA, Cooper LA. Provider and clinic cultural competence in a primary care setting. Soc Sci Med. 2008;66:1204–16.PubMedCrossRefGoogle Scholar
  13. 13.
    Stewart AL, Napoles-Springer A, Perez-Stable EJ. Interpersonal processes of care in diverse populations. Milbank Q. 1999;77:305, 39, 274.PubMedCrossRefGoogle Scholar
  14. 14.
    Kao AC, Green DC, Zaslavsky AM, Koplan JP, Cleary PD. The relationship between method of physician payment and patient trust. JAMA. 1998;280:1708–14.PubMedCrossRefGoogle Scholar
  15. 15.
    Anderson LA, Dedrick RF. Development of the trust in physician scale: A measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990;67:1091–100.PubMedGoogle Scholar
  16. 16.
    Lerman CE, Brody DS, Caputo GC, Smith DG, Lazaro CG, Wolfson HG. Patients' perceived involvement in care scale: Relationship to attitudes about illness and medical care. J Gen Intern Med. 1990;5:29–33.PubMedCrossRefGoogle Scholar
  17. 17.
    Wade P, Bernstein BL. Cultural sensitivity training and counselor's race: Effects on black female clients perceptions and attrition. J Counseling Psych. 1991;38:9–15.CrossRefGoogle Scholar
  18. 18.
    Fernandez A, Schillinger D, Grumbach K,et al. Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients. J Gen Intern Med. 2004;19:167–74.PubMedCrossRefGoogle Scholar
  19. 19.
    Thom DH, Tirado MD. Development and validation of a patient-reported measure of physician cultural competency. Med Care Res Rev. 2006;63:636–55.PubMedCrossRefGoogle Scholar
  20. 20.
    Gozu A, Beach MC, Price EG,et al. Self-administered instruments to measure cultural competence of health professionals: A systematic review. Teach Learn Med. 2007;19:180–90.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Kathryn A. Paez
    • 1
    Email author
  • Jerilyn K. Allen
    • 2
  • Mary Catherine Beach
    • 3
    • 4
    • 5
  • Kathryn A. Carson
    • 6
  • Lisa A. Cooper
    • 3
    • 4
    • 5
    • 6
    • 7
  1. 1.Center for Health Research and PolicySocial & Scientific Systems, Inc.Silver SpringUSA
  2. 2.Johns Hopkins University School of NursingBaltimoreUSA
  3. 3.Division of General Internal Medicine, Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins UniversityBaltimoreUSA
  5. 5.Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  6. 6.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  7. 7.Department of Health Policy & ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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