Pretty amazing stuff

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Doctors Dominate Talks With Black Patients



By Randy Dotinga
HealthDay Reporter

MONDAY, Dec. 13 (HealthDayNews) -- In another apparent indication of racial disparities in the U.S. health-care system, a new study suggests doctors are more likely to dominate conversations with black patients.



The findings, based on reviews of thousands of tape-recorded office visits, also show that race appears to affect the level of personal warmth in doctor-patient relationships.

"In the visits of African-Americans, the patients sounded less happy, less engaged, less interested, and so did the doctors," said study co-author Dr. Lisa A. Cooper, an associate professor of health policy and management at Johns Hopkins School of Medicine.

Previous research has shown a wide divide between medical treatment for blacks and whites. A recent study by University of California, Los Angeles researchers reported that white doctors were less likely to promptly prescribe drug treatments to black AIDS (news - web sites) patients.

"We've got two or three decades of research that has documented that ethnic minorities tend to receive fewer services and less appropriate services for a number of conditions," Cooper said.

In the new study, Cooper and her colleagues analyzed tape-recorded doctor visits involving 61 doctors and 458 patients in Washington, D.C., Baltimore, and northern Virginia. The visits took place in 1998 and 2002.

Thirty-one of the doctors were white, 20 were black and nine were of other races, Cooper said.

The researchers report their findings in the December issue of the American Journal of Public Health.

With black patients, the doctors were 23 percent more verbally dominant, according to the study. The ratio of physician comments to patient comments was 1.5 among whites -- meaning that doctors made three comments for every two patient comments -- and 1.7 among blacks.

"That suggests that in the visits of African-American patients, patients are talking less and asking fewer questions," Cooper said.

On another front, the researchers tried to gauge how well the doctors and patients interacted with each other. Among other factors, they looked at how often doctors asked questions about family and work, sought out the patient's opinion, and made expressions of concern or sympathy.

With black patients, the doctors were a third less likely to ask these types of questions and or to make these sorts of comments. The doctors were also less likely to use a "positive emotional tone," Cooper said.

So what's going on here? That's not clear. "We didn't ask people why they acted the way they did," Cooper said. "We just reported on that."

Dr. Winston Price, president of the National Medical Association, an organization of black doctors, said one issue could be an assumption by physicians that black patients are less educated. "Therefore, they tend to talk to those patients rather than communicate with them," he said.

There is some good news, though, Price noted. While the study suggested that inexperienced doctors may be more likely to treat black patients differently, young physicians are actually better prepared to deal with minorities, who often suffer from more than one illness. "Physicians coming out of training now are much better equipped to tackle patients with multiple conditions," he said.

Cooper said doctors should be more aware of the different ways they treat patients. "This is just a reminder to us to pay attention to our behavior and to think about what assumptions we're making about people when we interact with them, to raise our awareness of how our beliefs and attitudes might be influencing our behavior."

And while doctors may be partly to blame for poor communication, Cooper suggested that black patients can learn to do a better job of asserting themselves. They can "realize that it's OK to ask more questions and share more information, to give their opinions about what kinds of treatments they would prefer. Those are the big take-home messages." :eek:

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Edit: Since the title changed from "For those who think there is no racism in America" to "Pretty amazing stuff," my post is no longer valid.
 
This article is such garbage. It is just more evidence that you can always find what you are looking for in research. Come on now - this is crazy.
 
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"With black patients, the doctors were 23 percent more verbally dominant, according to the study. The ratio of physician comments to patient comments was 1.5 among whites -- meaning that doctors made three comments for every two patient comments -- and 1.7 among blacks."

Verbally domination..lol.
 
health disparities is a big issue. for you all to scoff at it....thats pretty sad.
 
VPDcurt said:
This article is such garbage. It is just more evidence that you can always find what you are looking for in research. Come on now - this is crazy.

The only thing that is crazy is to imply that this doesn't happen in medicine. :rolleyes:
 
Along these same lines I was watching a news show (Dateline or something like that) that studied peoples' reactions. They put average people (ie not previously trained) in front of one of those simulators that police use to practice shooting (without wasting bullets). The scenarios varied between a hostile situation, where the person could shoot, and a non-hostile situation, where you weren't supposed to shoot. Well, they found that most of the "accidental" shootings (ie people shot when it was a non-hostile situation) were against blacks. Furthermore, blacks were just as guilty of accidentally shooting other blacks, so there was no race disparity in terms of who was doing the shooting. It was really interesting to watch.
 
Khenon said:
Along these same lines I was watching a news show (Dateline or something like that) that studied peoples' reactions. They put average people (ie not previously trained) in front of one of those simulators that police use to practice shooting (without wasting bullets). The scenarios varied between a hostile situation, where the person could shoot, and a non-hostile situation, where you weren't supposed to shoot. Well, they found that most of the "accidental" shootings (ie people shot when it was a non-hostile situation) were against blacks. Furthermore, blacks were just as guilty of accidentally shooting other blacks, so there was no race disparity in terms of who was doing the shooting. It was really interesting to watch.

This is a very interesting subject. While I believe there is certainly racism involved, and I think it's a big problem, I can also see where it's coming from. The truth is, in many places, especially big cities, black people confronting police are more likely to have guns. I'm not making a judgement here, just a probable statement of fact. So, while police should be better trained not to shoot accidently, in some ways it makes sense for them to be more nervous in the situations with blacks; perhaps even in these training runs, their brains are just wired to expect more guns from the black scenario. But then I wonder if that's exactly the problem (expecting that), even if in reality it tends to be true, because it leads to so many sad situations.

I don't doubt that there is plenty of racism in medicine. If it's elsewhere, why not in medicine? My black friends have always said they get stopped more often while driving and treated more roughly when stopped, and my brother's friends (young black males) say it's even worse for them than for women. So why should I think that doctors are above cops in this matter? On the other hand, I've also seen reverse racism in my life. So it's also important for black patients not to be immediately dismissive of a white doctor, either.
 
Wow, talk about a ******ed study. This is your typical "I want to find something and surprise! I did!" study. This study is predicated on a false assumption that is quite glaring, and that is that the black patients are completely impartial people who are completely unbiased. That's how you can tell that this study was either (a) constructed by *****s or (b) constructed to "prove" that whitey be racist. Why not ask whether black patients act differently to white physicians versus black physicians? Oh, wait, no ...that would imply that the black patients were the ones who were racist and we all know that this is impossible. Or, alternatively, we could spin it to say that they acted differently ONLY BECAUSE THEY KNEW THE WHITES WERE RACIST. That's even better. Or, we could bring in 200 years of oppression or something.

Studies like this are hilarious because they let you know what the RESEARCHER wants you to think, rather than what the data actually shows. Another example is this: studies consistently show that male patients interact differently with female physicians. Now, if we went by the SAME POSTULATE as with the white-vs-black study, we would have to say that the females were to blame and who had to be more sensitive and unbiased to their patients. NO, YOU WOULD BE WRONG, SUCKAH!! It's the men at fault for being sexist against the women! See how that works?? It's awesome because I get to choose who is the bigot! And you know who I'm gonna pick!! YEE HAWW!!!!!
 
Well kinetic I think you're partly right, in that the study can be interpreted how you want. I think it's probably true that the interactions are different; like I said above, maybe due to both parties, the doctor AND the patient. Why does it have to be just one?
 
It is, indeed, both. But what's your point? Humans treat people differently and subjectively? Wow. Someone notify the press because I didn't know that. I was just pointing out that this study is ******ed and the only people who are lapping it up are people who want it (the conclusion) to be true.
 
regardless of this study and how valid it is there are plenty others that point out discriminatory practices in medicine.
 
...and which fail for the same reason.
 
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kinetic said:
Wow, talk about a ******ed study.

How can you comment on the quality of the study w/o reading it? I'm sure the article by HealthDayNews does no justice to the actual study.

kinetic said:
This study is predicated on a false assumption that is quite glaring, and that is that the black patients are completely impartial people who are completely unbiased.
I disagree. If the study based the results solely on the perceptions of black patients, than maybe so, but I doubt the researchers did this. I've read similar studies like the one the article is quoting and usually they have independent reviewers looking at the tapes and transcripts.
 
MadameLULU said:
How can you comment on the quality of the study w/o reading it? I'm sure the article by HealthDayNews does no justice to the actual study.

How can you comment on it?


MadameLULU said:
I disagree. If the study based the results solely on the perceptions of black patients, than maybe so, but I doubt the researchers did this. I've read similar studies like the one the article is quoting and usually they have independent reviewers looking at the tapes and transcripts.

No, I meant that the black patients bring THEIR own prejudices and subjective feelings into the interaction with the physician, too (not the people reviewing the tapes). In other words, a black guy goes to the white physician and HE THINKS the white guy hates him and is a big racist because everyone knows white people hate black people and so HE reacts differently to the physician.
 
kinetic said:
Why not ask whether black patients act differently to white physicians versus black physicians? Oh, wait, no ...that would imply that the black patients were the ones who were racist and we all know that this is impossible.!!!


Interestingly, I published research as an undergrad, and one of my findings was that minority patients actually PREFER a white physician. This was only a study about Michigan though. However, they felt that there were disparities in their health care.
 
kinetic said:
How can you comment on it?

I've read similar studies. :D


kinetic said:
No, I meant that the black patients bring THEIR own prejudices and subjective feelings into the interaction with the physician, too (not the people reviewing the tapes). In other words, a black guy goes to the white physician and HE THINKS the white guy hates him and is a big racist because everyone knows white people hate black people and so HE reacts differently to the physician.

Using actors as patients in a study would easily overcome that potential bias.

Anyhow, what pisses me off more than anything is those who say this doesn't exist in medicine. Of couse it does! It exists everwhere, but there are those premeds and even physicians who profess they will or already do treat their patients the same. Study after study has shown that non minority physicians are more likely to communicate less or even prescribe inferior treatment to blacks and other minorities.
 
MadameLULU said:
I've read similar studies. :D

...which fail on the same point.


MadameLULU said:
Using actors as patients in a study would easily overcome that potential bias.

No, not really. Actors are human, as well.

MadameLULU said:
Anyhow, what pisses me off more than anything is those who say this doesn't exist in medicine. Of couse it does! It exists everwhere, but there are those premeds and even physicians who profess they will or already do treat their patients the same. Study after study has shown that non minority physicians are more likely to communicate less or even prescribe inferior treatment to blacks and other minorities.

That's right. It pisses me off that people won't acknowledge that they hate blacks, too.
 
You know, the conclusions of the study, while maybe noteable, do NOT fit the definition of racism anyway. People modify their behavior with different people in different situations, racism involves hate.
 
medic170 said:
You know, the conclusions of the study, while maybe noteable, do NOT fit the definition of racism anyway. People modify their behavior with different people in different situations, racism involves hate.

A more appropriate term is health care delivery disparties...which can go under the general title of health care disparities
 
1. Disparities does not equal racism.

2. While I am forced to assume that a difference in 0.2 words by the patient/doctor between the white patient and the black patient is statistically significant (even though I question how close it is to the line) since the study is published, I do question how clinically significant the condition is! Is study like the studies that show that code 3 responses to emergencies by EMS is shown to save time (about 1-2 minutes on average), but for the average patient, 1-2 minutes isn't worth the extra risk of being in a MVA? Yes, there is a differences, but is someone really going to die because there is a 0.2 word difference?

Equality is not equality of outcome, it is equality of opportunity. As long as all people have a chance to ask questions, it no longer becomes my worry that people utilize it.
 
I find it odd that they didnt publish any info on the comparison between the white physician and the black physician interacting with the black patient.

Also, without watching some tapes, its hard to say if the physician or the patient is causing the outcome. The patient could be asking fewer questions, or the doc could be preventing them from doing so. If the former, it could be a cultural difference: perhaps the black community has more 'faith' in the physician, as some other countries cultures do..

Just hypothetically here..
 
Siggy said:
1. Disparities does not equal racism.
True. Nobody ever said it did.

Siggy1 said:
2. I do question how clinically significant the condition is!
very clinically significant. For example, if physicans are less likely to communicate with ethnic minorities, perhaps the patients will be less likely to comply with taking their medications correctly.

Siggy1 said:
Equality is not equality of outcome, it is equality of opportunity. As long as all people have a chance to ask questions, it no longer becomes my worry that people utilize it.

It's not just about the patient asking questions, it's also about communicating effectively with the patient. If physicians aren't communicating well with patients, then they aren't doing their job!
 
Siggy said:
1. Disparities does not equal racism.

2. While I am forced to assume that a difference in 0.2 words by the patient/doctor between the white patient and the black patient is statistically significant (even though I question how close it is to the line) since the study is published, I do question how clinically significant the condition is! Is study like the studies that show that code 3 responses to emergencies by EMS is shown to save time (about 1-2 minutes on average), but for the average patient, 1-2 minutes isn't worth the extra risk of being in a MVA? Yes, there is a differences, but is someone really going to die because there is a 0.2 word difference?

Equality is not equality of outcome, it is equality of opportunity. As long as all people have a chance to ask questions, it no longer becomes my worry that people utilize it.
It certainly is our worry. If patients aren't utilizing a heath care system equally, and the only difference is race, that means there are systemic prejudices preventing equal care. Yes, unequal utilization is unequal care. We need to identify what factors cause these disparities in access and utilization, be them unconscious actions by doctors, other providers, patients, society, whoever.

That being said, the article noted that there are generalized population differences, stating that the minority population tends to have multiple conditions that need to be considered. I wonder if their quanification of doctor-patient banter accounts for the complexity of the patient. That is, does it make sense a doctor would talk more when the patient has a complicated history? I think so.

Needless to say, I find the reported lack of interest in the personal lives of and bedside manner with minority patients highly disturbing. This testifies to a still existing, albeit unconscious, prejudice even in our country's educated and informed. We have a lot of work to do.

-dope-
 
dopaminophile said:
Needless to say, I find the reported lack of interest in the personal lives of and bedside manner with minority patients highly disturbing. This testifies to a still existing, albeit unconscious, prejudice even in our country's educated and informed. We have a lot of work to do.

Yeah, we're all racists because we don't agree with the conclusions of the study. Isn't that "troubling" and "worrysome"? I like how you've positioned it:

Either we DO agree with the study, in which case we agree that we are all racist because we don't care about black health care disparities and, in fact, are responsible for said disparities.

Or we DON'T agree with the study, in which case that simply proves that we are racist because we are "uninterested" in studies that show racism and disparities in minority health care.

It's another lesson in how liberals work. Enjoy.
 
Oh yeah lets make this into a ******ed liberal/conservative argument! :thumbup:
 
Or even better, let's pretend it's not! :thumbup:
 
Yeah, we're all racists because we don't agree with the conclusions of the study
Is that what I said AT ALL? No... Certainly you understand the difference between racist and prejudice. If there is a difference in care, there is a prejudice by definition. That doesn't mean that people are bad; it doesn't mean people are racist; it means that WE HAVE A LOT OF WORK TO DO. You neo-conservative psychos are so afraid that people are calling you racist or judging you that it's completely paralyzed your ability to think or listen.

because we don't care about black health care disparities
If you don't care about disparities in health care, then you shouldn't be a provider. It doesn't matter if it is a black/white, republican/democratic, yankee/southerner, left-handed/right-handed disparity. Any inequality in access or utilization of health care is unacceptable. We must all care if we're going to successfully gain and maintain the trust of the public... which is slipping away more and more rapidly.

Your mischaracterization of what I said is even more absurd now that I read it again because the quote that you gave didn't even address the part of the study that you had a problem with! You were questioning whether 0.2 comments was statistically significant, which is fine, but I was talking about the 33% discrepancy regarding "interest in the personal lives of and bedside manner with minority patients." That is highly disturbing!

-dope-
 
kinetic said:
Yeah, we're all racists because we don't agree with the conclusions of the study.

Conservatives always jump to conclusions. Yeah, this statement is just as ludicrous and absurd as the quoted text and your entire post. :rolleyes:
 
dopaminophile said:
Certainly you understand the difference between racist and prejudice.

Oh, I see ...it's just prejudice ...based on race ...HOLY S**T!!! That's racism! HA HA HA! Yeah, we're SO AFRAID of being called racist. Hmm ...maybe that's because you liberals are so cavalier about throwing that word around all the time. "I didn't get the job I wanted ...RACISM!" "I got pulled over when I was speeding ...RACISM!" "They screened me at the airport ...RACISM!"
 
MadameLULU said:
Conservatives always jump to conclusions.

And liberals decry broad-based generalizations (or so they would have you believe).
 
dopaminophile said:
If there is a difference in care, there is a prejudice by definition.

Oh, by the way, you better look up "prejudice," since you're such an expert in it. Just to key you in, differences don't equal prejudice.
 
kinetic said:
Oh, I see ...it's just prejudice ...based on race ...HOLY S**T!!! That's racism! HA HA HA! Yeah, we're SO AFRAID of being called racist. Hmm ...maybe that's because you liberals are so cavalier about throwing that word around all the time. "I didn't get the job I wanted ...RACISM!" "I got pulled over when I was speeding ...RACISM!" "They screened me at the airport ...RACISM!"
I didn't use the word "racism" a single time in my first post, nor did the article use it once. You brought up the topic, you brought up the issue, and now you're making an *ss out of yourself and grossly mischaracterizing the entire conservative philosophy. I have a lot more respect for the actual conservative agenda than I have for your paranoid delusions.
 
dopaminophile said:
I didn't use the word "racism" a single time in my first post, nor did the article use it once. You brought up the topic, you brought up the issue, and now you're making an *ss out of yourself and grossly mischaracterizing the entire conservative philosophy. I have a lot more respect for the actual conservative agenda than I have for your paranoid delusions.

On the agenda for dopaminophile:

1) Look up the word "prejudice" and learn how to use it in a proper manner, rather than the knee-jerk and stupid way you do currently.

2) Continue to pretend that calling people "prejudiced" about race does not constitute calling them racists. Either that or continue to be condescending and pretend that nobody understands what you're getting at in your posts. Either one works.

That should fill up your afternoon.
 
dopaminophile said:
A prejudice is "a preconceived judgment or opinion," so says Webster. If you can think of any other reason for differences in care when all else is equal, I'm all ears.

Ah, so now a difference in health care equals "preconceived judgements or opinions." Ain't life grand for liberals? It's great because you guys all pat each other on the backs about stuff like this and so you figure you must be right.

[EDIT: Ouch! Don't delete your posts just because they make no sense! Where's the fun in that?]
 
kinetic said:
On the agenda for dopaminophile:

1) Look up the word "prejudice" and learn how to use it in a proper manner, rather than the knee-jerk and stupid way you do currently.

2) Continue to pretend that calling people "prejudiced" about race does not constitute calling them racists. Either that or continue to be condescending and pretend that nobody understands what you're getting at in your posts. Either one works.

That should fill up your afternoon.

Can you believe this guy? How condescending can you possibly be? I'm surprised he hasn't called you a ***** yet. (Although I'm sure both of us are in for it)
 
davidus said:
Can you believe this guy? How condescending can you possibly be? I'm surprised he hasn't called you a ***** yet. (Although I'm sure both of us are in for it)

Hey, you know what you are already, so there's really no need to say much more.
 
Okay wait . . . am I a racist because I'm liberal? :confused:

I'M KIDDING!! Lighten up you guys. Geez. I'm pretty sure the point is to be aware, not to jump to far left or far right conclusions.
 
kinetic said:
Ah, so now a difference in health care equals "preconceived judgements or opinions." Ain't life grand for liberals? It's great because you guys all pat each other on the backs about stuff like this and so you figure you must be right.

Wrong. Preconceived judgements or opinions can lead to disparities in health care.

Why are you making this into an argument about liberals and conservatives? It has nothing to do it.
 
davidus said:
Can you believe this guy? How condescending can you possibly be? I'm surprised he hasn't called you a ***** yet. (Although I'm sure both of us are in for it)
What scares me is that kid might actually be in charge of someone's well-being someday. I ache for his poor patients.
 
MadameLULU said:
Wrong. Preconceived judgements or opinions can lead to disparities in health care.

Yes, indeedy. But that's not the order in which we came to the conclusion, was it? We started out by noting that there were disparities and health care and YOU ALL screamed prejudice. Thanks for trying, though.

Note the distinct difference in these statements:

Prejudice can lead to disparities in health care.

Disparities in health care reflect prejudice.

I know this will take a while.
 
dopaminophile said:
What scares me is that kid might actually be in charge of someone's well-being someday. I ache for his poor patients.

And yet you still don't know what "prejudice" is. Maybe you should ache for some knowledge instead.
 
I think that there is a bias that exists in medicine today that works against certain ethnic minority groups (this is evidenced by the many health disparities between ethnic minorities and the general population), but this study's methodology has a lot of BS in it. It's like they are trying to show that bias exists, by finding anything, albeit trivial, to indicate an important matter in a dishonest way. :thumbdown:
 
"Everyone's a little bit racist..."
Avenue Q...great show, highly recommended.
Everybody lighten up. All you can do is control your own career as a physician and make sure you give each and every patient your utmost attention and compassion as a health care professional. Is it possible this study hints at some large-scale problem within healthcare circles and/or educational facilities? Maybe. But how would you ever go about rectifying this? Or proving that you've rectified it? Better yet, what if a study comes out next year that contradicts this one? Are we going to implement racial sensitivity courses into our medical schools or residency programs? I think racial relations/equality is as important as anything else in our culture, but I really am not that alarmed by this study. And I'm socially liberal, how about that.
 
kinetic said:
Yes, indeedy. But that's not the order in which we came to the conclusion, was it? We started out by noting that there were disparities and health care and YOU ALL screamed prejudice. Thanks for trying, though.

Note the distinct difference in these statements:

Prejudice can lead to disparities in health care.

Disparities in health care reflect prejudice.

I know this will take a while.

Um, wrong again. I never said that disparities in health care are due just to prejudices. :rolleyes:
 
fruit fly said:
I think that there is a bias that exists in medicine today that works against certain ethnic minority groups (this is evidenced by the many health disparities between ethnic minorities and the general population), but this study's methodology has a lot of BS in it. It's like they are trying to show that bias exists, by finding anything, albeit trivial, to indicate an important matter in a dishonest way. :thumbdown:
If you're trying to quantify an inherently qualitative issue, I can't think of another way they could have done it. Clearly the study was statistically significant with t- and q- tests a flyin'. That isn't to say that it's fool-proof, but I think that certain reasonable conclusions can be made. I just don't know how else you can study the quality of patient-doctor banter, the most critical exchange of information in medicine.
 
MadameLULU said:
Um, wrong again. I never said that disparities in health care are due just to prejudices. :rolleyes:

Aw, you're still having trouble reading. Now try these two sentences.

Disparities in health care reflect prejudice.

Disparities in health care are due just to prejudices.

Soon you will be able to read. Fear not.
 
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