Patient and provider assessments of adherence and the sources of disparities: evidence from diabetes care.
Lutfey KE, Ketcham JD. Health Serv Res.2005 Dec;40(6 Pt 1):1803-17.
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The authors surveyed 156 pairs of patients and their physicians from two Midwestern subspecialty endocrinology clinics, focusing on the correlation of each patient’s perception of his or her adherence to treatment with the attending physician’s perception of that patient’s compliance.
The primary finding was that the difference between the clinician and patient estimates of adherence was significantly greater if the patient were black than if the patient were white, but the direction of the variation of a provider’s assessment from a black patient’s assessment was random; i.e., clinicians did not show a tendency to assess the black patient as being either more adherent or less adherent than the patient’s self-evaluation.
The authors conclude that “providers appear to rely on observable cues, particularly age and race, to make inferences about an individual patient’s adherence,” and suggest that further investigation of the cognitive processing of providers, “particularly in terms of distinguishing between prejudice and uncertainty,” could provide clinically useful information.
Commentary
It’s heartening to find such an investigation of cultural and racial differences that eschews reflexive, implicit accusations of racism in favor of scientific observation. And I, for one, believe that improvement in patient-clinician communication is far more likely to be the consequence of providers learning to correct their misinterpretations rather than attempting to somehow become more “culturally sensitive.”
