Abstract
Certain barriers can impede opportunities to learn what matters to people and to achieve a successful clinical encounter. A multicultural physician and patient population present a dual and sometimes formidable barrier when providing appropriate and equal health care access. There is extensive study of individual and systemic barriers to positive encounters, and thus the health-care system is evolving and slowly becoming more aware of necessary ingredients for achieving successful health outcomes. We are improving, but have a long way ahead. This chapter focuses on the patient–physician encounter, factors determining its success or failure, effects on treatment decisions and health-care outcomes, and steps to develop it to an expected standard in health care. While dedicated to physicians, the information shared in this chapter is applicable to all health care professionals.
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References
Task SAEM. Force on physician-patient communication: physician-patient communication in the emergency department. Part 2: communication strategies for specific situations. Acad Emerg Med. 1996;3:1146.
Miranda Jr D, Sanchez DJ. The Tuskegee experiment: an introduction in ethics for pre-healthcare professional students. J Microbiol Biol Educ. 2014;15:232–4.
Boulware LE, Cooper LA, Ratner LE, La Veist TA, Powe NR. Race and trust in the healthcare system. Public Health Rep. 2003;118:358–65.
Gamble VN. Under the shadow of Tuskegee: African Americans and health care. Am J Public Health. 1997;87:1773–8.
Mansh M, Garcia G, Lunn MR. From patients to providers: changing the culture in medicine toward sexual and gender minorities. Acad Med. 2015;90:574–80.
Cleary PD, Meterko M, Wright SM, Zaslavsky AM. Are comparisons of patient experiences across hospitals fair? A study in Veterans Health Administration hospitals. Med Care. 2014;52:619–25.
Merlino J, Rice S. Getting past the ‘tribal mentality’ to improve the patient experience. Mod Healthc. 2014;44:42–3.
Commonwealth Fund 2001 Health Care Quality Survey.
Xu KT, Borders TF, Arif AA. Ethnic differences in parents’ perception of participatory style of their children’s physicians. Med Care. 2004;42:328–35.
Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health. 2004;94:2084–90.
Roter DL, Hall JA. How physician gender shapes the communication and evaluation of medical care. Mayo Clin Proc. 2001;76:673–6.
Boulware LE, Ratner LE, Cooper LA, Sosa JA, LaVeist TA, Powe NA. Understanding disparities in donor behavior: race, and gender differences in willingness to donate blood and cadaveric organs. Med Care. 2002;40:85–95.
The Kaiser Family Foundation National Survey of Physicians. Part 1: doctors on disparities in medical care (2002).
Saha S, Arbelaez JJ, Cooper LA. Patient-physician relationships and racial disparities in the quality of healthcare. Am J Public Health. 2003;94:1713–9.
Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in healthcare. Institute of Medicine. 2002.
Pacheco CM, Daley SM, Brown T, Filippi M, Greiner KA, Daley CM. Moving forward: breaking the cycle of mistrust between American Indians and researchers. Am J Public Health. 2013;103:2152–9.
Waseem M, Ryan M. “Doctor” or “doctora”: do patients care? Pediatr Emer Care. 2005;205:515–7.
Park ER, Chun MB, Betancourt JR, Green AR, Weissman JS. Measuring residents’ perceived preparedness and skillfulness to deliver cross-cultural care. J Gen Intern Med. 2009;24:1053–6.
Green AR, Betancourt JR, Park ER, Greer JA, Donahue EJ, Weissman JS. Providing culturally competent care: residents in HRSA Title VII funded residency programs feel better prepared. Acad Med. 2008;83:1071–9.
Green AR, Miller E, Krupat E, White A, Taylor WC, Hirsh DA, et al. Designing and implementing cultural competence OSCE: lessons learned from interviews with medical students. Ethn Dis. 2007;17:344–50.
Lopez L, Vranceanu AM, Cohen AP, Betancourt J, Weissman JS. Personal characteristics associated with resident physicians’ self perceptions of preparedness to deliver cross-cultural care. J Gen Intern Med. 2008;23:1953–8.
Park ER, Betancourt JR, Miller E, Nathan M, MacDonald E, Ananeh-Firempong 2nd O, et al. Internal medicine residents’ perceptions of cross-cultural training. Barriers, needs, and educational recommendations. J Gen Intern Med. 2006;21:476–80.
Kumagal AK, Lypson ML. Beyond cultural competence: critical consciousness, social justice and multicultural education. Acad Med. 2009;84:782–7.
Hamilton G, Marco CA. Emergency medicine education and health care disparities. Acad Emerg Med. 2003;10:1189.
Hobgood C, Sawning S, Bowen J, Savage K. Teaching culturally appropriate care: a review of educational models and methods. Acad Emerg Med. 2006;13:1288.
Flores G. Providing culturally competent pediatric care: integrating pediatricians, institutions, families, and communities into the process. J Pediatr. 2003;143:1.
Scott CJ, Martin M, Hamilton G. Training of medical professionals and the delivery of health care as related to cultural identity groups. Acad Emerg Med. 2003;10:1149.
Ko M, Heslin KC, Edelstein RA, Grumbach K. The role of medical education in reducing health care disparities: the first ten years of the UCLA/Drew Medical Education Program. J Gen Intern Med. 2007;22:625–31.
Dhaliwal JS, Crane LA, Valley MA, Lowenstein SR. Student perspectives on the diversity climate at a U.S. medical school: the need for a broader definition of diversity. BMC Res Notes. 2013;6:154.
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 Suppl 1:S21–7. Review.
Powe NR, Cooper LA. Disparities in patient experiences, health care processes, and outcomes: The role of patient-provider racial, ethnic, and language concordance [Internet]. 2004. Available from: http://www.commonwealthfund.org/publications/fund-reports/2004/jul/disparities-in-patient-experiences--health-care-processes--and-outcomes--the-role-of-patient-provide
Lin X, Guan J. Patient satisfaction and referral intention: effect of patient-physician match on ethnic origin and cultural similarity. Health Mark Q. 2002;20:49–68.
Street Jr RL, O’Malley KJ, Cooper LA, Haidet P. Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity. Ann Fam Med. 2008;6(3):198–205.
Persky S, Kaphingst KA, Allen Jr VC, Senay I. Effects of patient-provider race concordance and smoking status on lung cancer risk perception accuracy among African-Americans. Ann Behav Med. 2013;45(3):308–17.
Johnson Thornton RL, Powe NR, Roter D, Cooper LA. Patient-physician social concordance, medical visit communication and patients’ perceptions of health care quality. Patient Educ Couns. 2011;85(3):e201–8. doi:10.1016/j.pec.2011.07.015.
Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;11:907–15.
Arguete MS, Roberts CA. Participants’ ratings of male physicians who vary in race and communication style. Psychol Rep. 2002;91:793–806.
Suarez-Almazor ME. Patient-physician communication. Curr Opin Rheumatol. 2004;16:91–5.
Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004;27:237–51.
American Medical Association. Patient-centered communication [cited 2015 February 2]. Chicago, IL: American Medical Association; c 1995-2015. Available from: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/the-ethical-force-program/patient-centered-communication.
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(2):101–10.
Haider AH, Sexton J, Sriram N, Cooper LA, Efron DT, Swoboda S, et al. Association of unconscious race and social class bias with vignette-based clinical assessments by medical students. JAMA. 2011;306:942–51.
Cone DC, Richardson LD, Todd KH, Betancourt JR, Lowe RA. Health care disparities in emergency medicine. Acad Emerg Med. 2003;10:1176.
Cohen JJ. Disparities in health care: an overview. Acad Emerg Med. 2003;10:1155.
Todd KH, Samaroo N, Hoffman JR. The effect of ethnicity on physician estimates of pain severity in patients with isolated extremity trauma. JAMA. 1994;271:925.
Todd KH, Deaton C, D’Adamo AP, Goe L. Ethnicity and analgesic practice. Ann Emerg Med. 2000;35:11.
Bazarian JJ, Pope C, McClung J, Cheng YT, Flesher W. Ethnic and racial disparities in emergency department care for mild traumatic brain injury. Acad Emerg Med. 2003;10:1209.
Wall SP, Ha ES, Habicht ME, Wawda H, Merchant GL, Ettner SL, et al. Impact of patient race on receiving heat CT during blunt head injury evaluation. Acad Emerg Med. 2005;12:862.
Harris B, Hwang U, Richardson LD, Lee W. Disparities in computed tomography utilization for adult patients presenting to the emergency department with headache. Ann Emerg Med. 2007;50:S120.
Richardson LD, Irvin CB, Tamayo-Sarver JH. Racial and ethnic disparities in the practice of emergency medicine. Acad Emerg Med. 2003;10:1184.
James TL, Feldman J, Mehta SD. Physician variability in history taking when evaluating patients presenting with chest pain in the emergency department. Acad Emerg Med. 2006;13:147.
van Ryn M, Burke J. The effects of race and socioeconomic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50:813.
Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28(11):1504–10.
Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, Iezzoni LI, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231–8.
Sewell JL, Velayos FS. Systematic review: the role of race and socioeconomic factors on IBD healthcare delivery and effectiveness. Inflamm Bowel Dis. 2013;19:627–43.
Mississippi Public Broadcasting Radio. Racial bias in health care: an interview with Dr. Claudia Fegan [Internet]. 2013. Chicago, IL: Physicians for National Health Program; c 2015. [cited 2015 February 6]. Available from: http://www.pnhp.org/news/2013/may/racial-bias-in-health-care-an-interview-with-dr-claudia-fegan .
Corbin TJ, Rich JA, Bloom SL, Delgado D, Rich LJ, Wilson AS. Developing a trauma-informed, emergency department-based intervention for victims of urban violence. J Trauma Dissociation. 2011;12:510–25.
Cunningham R, Knox L, Fein J, Harrison S, Frisch K, Walton M, et al. Before and after the trauma bay: the prevention of violent injury among youth. Ann Emerg Med. 2009;53:490–500.
Becker MG, Hall JS, Ursic CM, Jain S, Calhoun D. Caught in the crossfire: the effects of a peer-based intervention program for violently injured youth. J Adolesc Health. 2004;34:177–83.
Cheng TL, Haynie D, Brenner R, Wright JL, Chung S, Simons-Morton B. Effectiveness of a mentor-implemented, violence prevention intervention for assault-injured youths presenting to the emergency department: Results of a randomized trial. Pediatrics. 2008;122:938–46.
Fein JA, Kassam-Adams N, Gavin M, Huang R, Blanchard D, Datner EM. Persistence of posttraumatic stress in violently injured youth seen in the emergency department. Arch Pediatr Adolesc Med. 2002;156:836–40.
Ketterlinus RD, editor. Youth violence: Interventions for health care providers. Washington, DC: The American Public Health Association; 2008.
Purtle J, Dicker R, Cooper C, Corbin T, Greene MB, Marks A, et al. Hospital-based violence intervention programs save lives and money. J Trauma Acute Care Surg. 2013;75:331–3.
Shibru D, Zahnd E, Becker M, Bekaert N, Calhoun D, Victorino GP. Benefits of a hospital-based peer intervention program for violently injured youth. J Am Coll Surg. 2007;205:684–9.
James TL, Bibi S, Langlois BK, Elizabeth Dugan E, Mitchell PM. Boston violence intervention advocacy program: a qualitative study of client experiences and perceived effect. Acad Emerg Med. 2014;21(7):742–51. doi:10.1111/acem.12409.
Thornton TN, Craft CA, Dahlberg LL, Lynch BS, Baer K (eds). Best practices of youth violence prevention: A sourcebook for community action. [Internet]. Atlanta, GA: CDC; 2002 [cited 2013 Aug 1]. Available from: http://www.cdc.gov/violenceprevention/pub/yv_bestpractices.html.
United States Department of Justice. Report of the Attorney General’s national task force on children exposed to violence [Internet]. 2012 [cited 2013 Aug 1]. Available from: http://www.justice.gov/defendingchildhood/cev-rpt-full.pdf.
Karraker N, Cunningham RM, Becker MG, Fein JA, Knox LM. Violence is preventable: A best practices guide for launching and sustaining a hospital-based program to break the cycle of violence. Replication Guide was produced by Youth ALIVE! under grant # 2009-SZ-B9-K004, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. 2011 [cited 2013 Sept 23]. Available from: http://youthalive1.squarespace.com/storage/ViolenceisPreventableOnline.pdf.
Cheng TL, Schwarz D, Brenner RA, Wright JL, Fields CB, O’Donnell R, et al. Adolescent assault injury: risk and protective factors and locations of contact for intervention. Pediatrics. 2003;112:931–8.
Cooper C, Eslinger D, Nash D, al-Zawahri J, Stolley P. Repeat victims of violence: report of a large concurrent case-control study. Arch Surg. 2000;135:837–43.
National Center for Trauma Informed Care. Models for developing trauma-informed behavioral health systems and trauma-specific service [Internet]. 2008 [cited 2013 Dec 4]. Available from: www.uwgb.edu/bhtp/tools/developing_trauma.
National Center for Trauma Informed Care. Report of project activities over the past 18 months, history, and selected products [Internet]. 2012 Mar 26 [cited 2013 Dec 4] Available from: http://www.nasmhpd.org/docs/NCTIC/NCTIC_Final_Report_3-26-12.pdf.
Kilpatrick DG, Acierno R, Saunders B, Resnick HS, Best C, Schnurr PP. Risk factors for adolescent substance abuse and dependence: data from a national sample. J Consult Clin Psychol. 2000;68:19–30.
National Network of Hospital-Based Violence Intervention Programs. Available from: www.nnhvip.org
Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49:796–804.
Saha S, Beach MC, Cooper LA. Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc. 2008;100:1275–85.
Hearld LR, Alexander JA. Patient-centered care and emergency department utilization: a path analysis of the mediating effects of care coordination and delays in care. Med Care Res Rev. 2012;69(5):560–80.
Beach MC, Saha S, Cooper LA. The role and relationship of cultural competence and patient-centeredness in health care quality [Internet]. 2006 [cited 2015 Feb 5]. Washington, DC: The Commonwealth Fund; c 2015. Available from: www.commonwealthfund.org/usr_doc/Beach_rolerelationshipcultcomppatient-cent_960.pdf
Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med. 2011;24(3):229–3.
Rickert J. Patient centered-care: What it means and how to get there. 2012. Health Affairs blog [Internet]. Millwood, VA: Project HOPE; c 1995-2015. [cited 2015 January 12]. Available from: http://healthaffairs.org/blog/2012/01/24/patient-centered-care-what-it-means-and-how-to-get-there/.
Kane GC, Gotto JL, Mangione S, West S, Hojat M. Jefferson scale of patient’s perceptions of physician empathy: preliminary psychometric data. Croat Med J. 2007;48:81–6.
National Standards for Culturally and Linguistically Appropriate Services in Health Care. Final report. Washington, DC: U.S. Department of Health and Human Services, Office of Minority Health; 2001. [cited 2015 February 2015]. Available from: http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf
Massachusetts Division of Medical Assistance: Appendix G: Cultural Competence QIP Reporting. Boston: Division of Medical Assistance; 1997.
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James, T. (2016). The Patient–Physician Clinical Encounter. In: Martin, M., Heron, S., Moreno-Walton, L., Jones, A. (eds) Diversity and Inclusion in Quality Patient Care. Springer, Cham. https://doi.org/10.1007/978-3-319-22840-2_7
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DOI: https://doi.org/10.1007/978-3-319-22840-2_7
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