Einbinder L C, Schulman K A
Georgetown University Medical Center, USA.
Med Care Res Rev. 2000;57 Suppl 1:162-80. doi: 10.1177/1077558700057001S08.
Coronary artery disease is the leading cause of death in the United States. Blacks are more likely than whites to experience premature disease, and they have poorer prognosis after acute myocardial infarction. Multiple studies have demonstrated that blacks are less likely to be referred for certain invasive cardiac procedures. Few studies have examined the effect of race on physician and patient decision making in referrals for cardiac procedures. The authors present a framework for the complex series of steps involved in obtaining invasive cardiac care. Patient race can affect each of these steps, and differences in physician and patient race may be a particular impediment to effective communication about symptoms and preferences and to the establishment of a therapeutic partnership. The potential role of communication in race-discordant physician-patient relationships suggests a need for more research in physician decision making and for efforts to promote cultural competency as a core component of medical education.
冠状动脉疾病是美国的主要死因。黑人比白人更易患早发性疾病，且急性心肌梗死后的预后更差。多项研究表明，黑人接受某些侵入性心脏手术的转诊可能性较小。很少有研究探讨种族对心脏手术转诊中医护人员和患者决策的影响。作者提出了一个涉及获得侵入性心脏护理的一系列复杂步骤的框架。患者的种族会影响这些步骤中的每一个，医护人员与患者种族的差异可能特别妨碍就症状和偏好进行有效沟通以及建立治疗伙伴关系。沟通在种族不匹配的医患关系中的潜在作用表明，需要对医护人员的决策进行更多研究，并努力将文化能力提升作为医学教育的核心组成部分。
