van Ryn M, Burke J
Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, Rensselaer, NY 12144-3456, USA.
Soc Sci Med. 2000 Mar;50(6):813-28. doi: 10.1016/s0277-9536(99)00338-x.
Despite its potential influence on quality of care, there has been little research on the way physicians perceptions of and beliefs about patients are affected by patient race or socio-economic status. The lack of research in this area creates a critical gap in our understanding of how patients' demographic characteristics influence encounter characteristics, diagnoses, treatment recommendations, and outcomes. This study uses survey data to examine the degree to which patient race and socio-economic status affected physicians' perceptions of patients during a post-angiogram encounter. A total of 842 patient encounters were sampled, out of which 193 physicians provided data on 618 (73%) of the encounters sampled. The results of analyses of the effect of patient race and SES on physician perceptions of and attitude towards patients, controlling for patient age, sex, race, frailty/sickness, depression, mastery, social assertiveness and physician characteristics, are presented. These results supported the hypothesis that physicians' perceptions of patients were influenced by patients' socio-demographic characteristics. Physicians tended to perceive African-Americans and members of low and middle SES groups more negatively on a number of dimensions than they did Whites and upper SES patients. Patient race was associated with physicians' assessment of patient intelligence, feelings of affiliation toward the patient, and beliefs about patient's likelihood of risk behavior and adherence with medical advice; patient SES was associated with physicians' perceptions of patients' personality, abilities, behavioral tendencies and role demands. Implications are discussed in terms of further studies and potential interventions.
尽管其对医疗质量可能产生影响，但关于患者种族或社会经济地位如何影响医生对患者的认知和信念，相关研究却很少。该领域研究的匮乏，使我们在理解患者人口统计学特征如何影响诊疗过程特征、诊断、治疗建议及结果方面存在关键空白。本研究利用调查数据，考察在血管造影术后诊疗过程中患者种族和社会经济地位对医生患者认知的影响程度。总共抽取了842次患者诊疗样本，其中193名医生提供了所抽取的618次（73%）诊疗的数据。呈现了在控制患者年龄、性别、种族、虚弱/疾病、抑郁、掌控感、社交自信及医生特征的情况下，患者种族和社会经济地位对医生患者认知及态度影响的分析结果。这些结果支持了如下假设：医生对患者的认知受患者社会人口统计学特征的影响。在多个维度上，医生往往对非裔美国人以及中低社会经济地位群体的患者持更负面的看法，相比之下，他们对白人及高社会经济地位患者的看法则较为积极。患者种族与医生对患者智力的评估、对患者的亲近感、对患者发生风险行为可能性及遵医嘱情况的信念相关；患者社会经济地位与医生对患者个性、能力、行为倾向及角色需求的认知相关。文中从进一步研究和潜在干预措施方面讨论了研究意义。
