Chen Mingda, Strony John T, Kroneberger Elizabeth A, Karns Michael R, Salata Michael J, Voos James E, Gillespie Robert J, Brown Marsalis C
Case Western Reserve University School of Medicine, Cleveland, Ohio.
Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
J Bone Joint Surg Am. 2023 Nov 1;105(21):1703-1708. doi: 10.2106/JBJS.23.00071. Epub 2023 Oct 6.
Orthopaedic surgery in the U.S. historically has been among the least demographically diverse specialties in medicine. Currently, limited data exist on how patients perceive diversity within the field and what patients look for when choosing an orthopaedic surgeon. The purpose of this study was to identify specific patient preferences for surgeon demographics and understand patient perceptions of racial and gender diversity in orthopaedic surgery.
Nonconsecutive patients from orthopaedic clinics affiliated with a U.S. academic health system voluntarily completed a 39-item questionnaire that surveyed basic demographic information, perception of diversity, racial and gender preferences during surgeon selection, and perception of health-care inequalities. Bivariate analyses were used to test the association between patient-surgeon demographic variables and ratings of diversity. Multiple regression models were used to identify independent predictors of overall perceived diversity ratings.
A total of 349 patients (80.6% White, 17.9% Black, and 1.5% other) were analyzed. Black patients were more likely to experience difficulty relating to their surgeon than White patients (11.48% versus 2.29%; odds ratio [OR], 5.62; 95% confidence interval [CI], 1.55 to 21.1; p = 0.004). Moreover, Black patients were more likely to perceive racial bias from their surgeon than White patients (5.17% versus 0.37%; OR, 14.44; 95% CI, 1.14 to 766.29; p = 0.02). While the level of racial diversity perceived by White patients (2.57 of 10) was significantly higher than that perceived by Black patients (2.10 of 10) (p = 0.001), the absolute difference between these 2 figures was small, suggesting that both groups perceived racial diversity in orthopaedics to be low. White and Black patients differed in their importance ranking of a surgeon's race (p < 0.0001): Black patients ranked a surgeon's race with higher importance (mean, 3.49 of 10) when selecting a surgeon compared with White patients (1.45 of 10). Both male and female patients gave relatively low importance rankings for a surgeon's gender (mean, 1.58 of 10 and 2.15 of 10, respectively, p = 0.02).
Patients in this study did not perceive orthopaedic surgery as a diverse field (overall diversity rating, <3 of 10). There were significant racial and gender differences in patients' preferences for specific physician characteristics when choosing an orthopaedic surgeon, which may help explain some instances of perceived racial bias and difficulty relating to their orthopaedic surgeon.
在美国，骨科手术历来是医学领域中人口统计学差异最小的专业之一。目前，关于患者如何看待该领域的多样性以及患者在选择骨科医生时看重什么的资料有限。本研究的目的是确定患者对医生人口统计学特征的具体偏好，并了解患者对骨科手术中种族和性别多样性的看法。
来自美国一个学术健康系统附属骨科诊所的非连续患者自愿完成了一份包含39个项目的问卷，该问卷调查了基本人口统计学信息、对多样性的看法、选择医生时的种族和性别偏好以及对医疗保健不平等的看法。采用双变量分析来检验患者与医生人口统计学变量之间的关联以及多样性评分。使用多元回归模型来确定总体感知多样性评分的独立预测因素。
共分析了349名患者（80.6%为白人，17.9%为黑人，1.5%为其他种族）。与白人患者相比，黑人患者在与医生沟通时更有可能遇到困难（11.48%对2.29%；优势比[OR]，5.62；95%置信区间[CI]，1.55至21.1；p = 0.004）。此外，与白人患者相比，黑人患者更有可能察觉到医生存在种族偏见（5.17%对0.37%；OR，14.44；95%CI，1.14至766.29；p = 0.02）。白人患者感知到的种族多样性水平（10分制中的2.57分）显著高于黑人患者（10分制中的2.1分）（p = 0.001），但这两个数字之间的绝对差异很小，表明两组都认为骨科领域的种族多样性较低。白人和黑人患者在医生种族的重要性排名上存在差异（p < 0.0001）：与白人患者（10分制中的1.45分）相比，黑人患者在选择医生时将医生的种族看得更重要（10分制中的3.49分）。男性和女性患者对医生性别的重要性排名都相对较低（分别为10分制中的1.5分和2.15分，p = 0.02）。
本研究中的患者并不认为骨科手术是一个多样化的领域（总体多样性评分，10分制中<3分）。在选择骨科医生时，患者对特定医生特征的偏好存在显著的种族和性别差异，这可能有助于解释一些察觉到的种族偏见以及与骨科医生沟通困难的情况。
