Poor Provider/Patient Communication May Be More Common for Minority Patients
National guidelines for asthma care contained in the 1997 National Heart, Lung, and Blood Institute-sponsored expert panel report highlight the importance of active partnership between patients and physicians. This partnership is highly relevant for effective communication about asthma symptoms, medications, and appropriate self-management (eg, education to avoid triggers and intensify medication regimens during exacerbations). However, a number of studies have reported that differences in race and ethnicity between patients and their providers can represent important cultural barriers to effective communication and partnerships for care. Patient factors such as language barriers, low health literacy and educational status, and lack of self-efficacy, which may be more prevalent among low-income minorities, may contribute to the risk of poor patient/ provider communication in this population. Physician factors that may contribute to impaired communication between minority patients and their providers (often from dissimilar race/ethnicity as their patients) include unintentional racial biases in interpreting patient symptoms and decision making, and poor provider understanding of patients ethnic and cultural disease models and expectations from clinical encounters. Despite the fact that the great majority of health-care providers abhor prejudice and make every effort to deliver health care that is fair and equal to all patients, the Institute of Medicine report concluded that the preponderance of evidence suggests that inadvertent bias, stereotyping, prejudice, and clinical uncertainly are likely important contributing factors to Canadian health-care disparities, Finally, health-care system factors may also contribute to poor patient/provider communication, for example, by placing overly restrictive time constraints on the health-care encounter or by failing to have culturally and literacy-appropriate educational materials available for use by health-care professionals.
A previous report showed that physician attitudes toward their asthma patients may influence both the quality of communication and the quality of asthma care. Resulting impairments in communication may thus contribute to ineffectual partnerships for care between patients and their providers in managing chronic illnesses, leading to disparities in health outcomes from chronic disease such as asthma. In a study of office visits in primary care, Johnson et al, showed that physicians were more verbally dominant and engaged in less patient-centered communication with African-American than white patients. Positive affect was less apparent also for African Americans and their doctors compared with whites and their doctors.