The quality of care a patient receives is greatly influenced by the doctor-patient relationship. It serves as a platform for the collection of data, the development of plans and diagnoses, the achievement of compliance, and the promotion of healing, patient activation, and support. This social interaction between doctors and patients has recently attracted a lot of study attention. Racial, sexual, ethnic, gender, and social inequities in the American healthcare system have been demonstrated by compelling evidence. While many researchers have focused on the technical elements of care provision including procedures, tests, and therapies, a small number of studies have approached the subject in terms of interpersonal aspects of health care that may contribute to the existing disparities in access and outcome of these crucial services. The objective of this literature review is to answer these questions and help shade light on why minorities and people in the low socioeconomic statuses experience adverse health outcomes. The review will have two sections. One focusing on literature that discusses how the patient background including ethnicity, race, sex, gender, and socioeconomic status impact the care they receive while the other will analyze research focused on how the same backgrounds affect the selection of physicians by patients.
Patient's Background Impact on the Quality of Care
Among several technical issues, a patients' background has a substantial bearing on the superiority of healthcare they receive. Ferguson and Candib (2002), conducted an extensive literature review encompassing twenty-one articles with the aim of answering three key question. One, their paper analyzed evidence showing differences in language, race, and ethnicity between physicians and patients impact the quality of relationship and communication between the two and whether there is substantial outcome measure that supports this effect. Secondly, the authors analyzed whether improving the communication relationship between patients and doctors makes a difference in healthcare outcomes. Finally, their paper investigated whether adopting recommendations to diversify care providers workforce and training the existing workforce on being culturally and linguistically effective has an impact on the care outcomes. From their study, the authors found evidence to the three research questions and categorized them into two.
The first focuses on language barriers and how outcome problems are a precedence among non-fluent English speaking patients. According to them, approximately fourteen million Americans were not proficient in English by 1990. Five studies indicated the existence of a correlation between LES ability of patients and the perceived quality of care outcomes as compared to patients' with high proficiency in English. Three studies found a correlation between doctor-patients language concordance and quantifiable outcomes among Spanish Speaking patients.
The second categorization concentrated on evidence of physician bias where the authors argued that direct proof of this bias resulted from patient-doctor relationships involving Caucasian doctors and African American patients. Additionally, indirect evidence on the same was found in pain treatment facilities where the patients were either Hispanic or African American while the physicians were Caucasians. Ferguson & Candib (2002) argue that the difference provides evidence that patients from minority sections are less likely to engender empathic responses from their care provider, less liable to be provided with satisfactory information, unlikely to institute connections with physicians, and are also not likely to be encouraged to take part in medical decisions. Willems, Maesschalck, Deveugele, Derese, & Maeseneer (2005), took a similar approach in analyzing patient outcomes and the role of the patients' background in achieving these results. The study by Willems et al. (2005) concluded that communication between the patients and their physicians play a weighty role in the quality of care they receive. Their review showed evidence of care providers whose approach focused mostly on explaining and listening closely to patients from a high social status that to their counterparts from low socioeconomic classes. Similarly, they tended to provide advice and did more examinations on patients from lower classes.
The literature reviewed also showed evidence of patients coming from lower social classes received substantially less positive socio-emotional utterances, a more instructional and a less participatory approach in consulting. That the relationship between patients and their physicians is directly influenced by his social attributes like age, sex, gender, educational level, and generally by their economic statutes n the society. These impact the verbal and non-verbal communication techniques adopted by both the patient and the physicians and eventually affect the level of patients' satisfaction and the overall health outcomes. Unlike Ferguson & Candib (2002) and Willems et al. (2005), DeVoe, Wallace, & Fryer (2009) conducted an original study aimed at analyzing the role played by demographic factors in analyzing how patients perceive different aspects of communication between them and their physicians. According to the authors, despite the fact that national health care systems in the various countries adopt varying structures, they all share a common factor in the interaction of physicians and patients. Additionally, evidence shows that the quality of communication between the two closely correlates with the perception of high standards or care and the overall patient satisfaction. The study used a sample of adult patients from the U.S. to examine whether demographic factors had an independent relationship with various reports of perceived communication and explored the significance of their findings from a policy perspective.
DeVoe et al. found evidence of variations in care communication among the sample patients based on sex, race, gender, ethnicity, education, geographical residence, the common source of care, and their insurance statuses. In support of this, Cooper (2004) analyzed patient disparities in terms of experience, care processes, and outcomes and the role of race, ethnicity, and language concordance in the existence of these gaps. The author argues that disparities in race and ethnicity significantly impact care outcomes where minority group faces more difficulties in obtaining quality health care experiences and the results since they have difficulties in communicating and are often treated with some level of disrespect by care professionals from different ethnic groups. Similarly, the study found that physicians from minority groups often treat patients from their race of racial groups. In that, these doctors operate in areas with minimum healthcare workforce, care for poor patients, individuals with no insurance or Medicaid covers and individuals who report poor health statuses and often use severe health services. These results indicate that even though efforts are being made to improve diversity in the healthcare workforce, disparities persist since physician from minority groups are limited to in the patients they serve.
How Patients' Background Influence Selection
Cooper (2004) showed that a doctor's background especially those from minority groupings were limited to particular type of patients depending on their economic, racial, and ethnic backgrounds. The same phenomenon is portrayed in the manner patients choose their care providers. Garcia, Paterniti, Romano, & Kravitz (2003), analyzed this phenomenon by studying patients' preferences in terms of age, gender, and race or ethnicity concordant among their primary care providers. The study's guiding question was constructed in a manner in which it will extract information about what patients require when developing a relationship with their care providers. The results of their research showed that many patients found it necessary to maintain continuity of care and were not satisfied by the fact that they did not have the autonomous to choose who they preferred to be their care providers.
Despite this, Garcia et al.'s work found evidence of preferences based on demographic factors such as race and ethnicity, and gender. That members of one group, for example, Hispanics women or men, African American men or women, and English proficient groups preferred to be treated by physicians with similar demographic characteristics. The study, however, did not find any connections between the ages of the patients and their option for care providers. In the same light, Haron & Ibrahim (2012) argued that if these preferences are not addressed, many patients' participation in clinical consultation will be substantially affected. According to them, many factors affect the manner people communicate given the fact that it requires a standard set of rules to pass information between people effectively. Among these factors, patients choose their doctors based on emotional and physical traits resulting from concordances in areas such as age, gender, race, ethnicity, and beliefs about the disability of the physician or the patient. Haron & Ibrahim's study, however, concentrated on the role of ethnicity in determining the preferred doctor. The results showed that a significant number of people (Seventy-six percent of the participants) would actively participate in the consultation process when dealing with a physician from the same ethnic background.
On whether the patients would attend more consultations if the doctor involved were from the same ethnic group as them, thirty-six percent of the participants agreed with this. The authors argued that despite these small numbers, the responses on their perceived rate of participation in clinical consultations showed the high importance placed on ethnicity in such settings. Fennema, Meyer, & Natalie (1990), concentrated on how the sex of the doctor affected who patients choose to treat them. The study engrossed on four key areas including physician preference for specification and general ailments, physician stereotypes developed by patients, patient experience with female doctors and its relationship with choices, and the value of humane abilities compared to technical compliance. Fennema, Meyer, & Natalie's research involved a hundred and eighty-five adult participants and showed that forty-five present of these showed a preference for the physician gender. Forty-three and thirty-one percent of women and men respectively preferred to be treated by a doctor of the same sex as them. While twelve percent and nine percent of men and females respectively preferred the opposite sex. On stereotypes, more women were found to have the perception that men doctors are more humane while men found male physicians to be more technically competent.
Janssen, & Largo-Janssen (2011), took a different approach from the above studies. The two choose to analyze published literature discussing the relationship between the physician sex and women seeking obstetrical or gynecological care, the disparities in communication and personal satisfaction. The result of their review showed that most women preferred working with female gynecologists rather than their male counterparts. The reason behind these results according to the authors was that female gynecologists adopted a patient-centered approach to communication, their higher experience, and competence in the field.Although the studies selected in this review took varying approaches to the study of the effects of patient demographic backgrounds on the quality of care and preference of physicians, they provide conclusive evidence that sex, gender, race, ethnicity, and socioeconomic statuses play a critical role in the healthcare sector. The authors have provided statistical and empirical facts on how the different demographic element impact healthcare and how they affect the overall patient satisfaction thus partly explaining the disparities in care provision. This will provide a background, supporting information and the general direction of the rest of the paper given that it has yielded given an affirmative feedback on the research question.
References
Cooper, L., & Powe, N. (2004). Disparities in patient experiences, health care processes, and outcomes: The role of patient-provider racial, ethnic, and language concordance. Retrieved 01 June 2017 from http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2004/Jul/Disparities-in-Patient-Experiences–Health-Care-Processes–and-Outcomes–The-Role-of-Patient-Provide.aspx
DeVoe, J. E., Wallace, L. S., & Fryer, G. E. (2008). Measuring Patients’ Perception of Communication with Healthcare Providers: Do Differences in Demographic and Socioeconomic Characteristics Matter? Health Expectations, 12(2009), 70-80.
Fennema, K., Meyer, D. L., & Owen, N. (1990). Sex Physician: Patient’s Preferences and Stereotypes. Journal of Family Practice, 30(4), 441-446.
Fergusson, W. J., & Candib, L. M. (2002). Cutural Language and Doctor-Patient Relationship. Family medicine and Community Health, 34(5), 353-361.
Garcia, J. A., Paterniti, D. A., Romano, P. S. & Kravitz, R. I. (2003). Patient Preferences for Physician Characteristics in University-Based Primary Care Clinics. Ethnicity & Disease, 13(1), 259-267.
Haron, N. N., & Ibrahim, N. A. (2012). Patients’ Preference for Doctors: Perceptions of Patients at a Hematology Clinic. Procedia-Social and Behavioral Sciences, 66(2012), 187-195.
Janssen, S. M, & Lagro-Janssen, A. L. M. (2012). Physician’s Gender, Communication Style, Patient Preferences ad Satisfaction in Gynecological and Obstetrics: A Systematic Review. Patient Education and Counseling, 89(2012), 221-226.
Willems, A., Maesschalk, S., Dveugele, A., Derese, A., & Maeseneer, J. (2005) Socio-Economic Status of the Patient and Doctor-Patient Communication: Does it make a Difference? Patient Education and Counseling, 56(2005), 139-146.
