Abstract
Although socioeconomic and race-related factors both influence the quality of medical encounters, it is not known how these effects differ between racially concordant and discordant medical visits. The current study investigated psychosocial determinants of physician visit satisfaction of Black adults based on a racial concordance of the medical encounter. Data came from the Detroit Area Study, a community survey of adults in Michigan, United States. The current analysis included 336 Black individuals who had visited a White (n = 191) or a Black (n = 145) physician in the last year. The outcome was satisfaction with the quality of communication with the doctor. Demographics (age and gender), socioeconomic status (education and income), psychosocial factors (control beliefs and social support), race-related factors (having a close White friend, negative attitudes about Blacks, discrimination), and health status (chronic disease count, self-rated health, and distress) of the patient as well as race of the doctor were measured. We used multi-group structural equation modeling for data analysis, where the two groups were racially concordant (those who met a Black physician) and racially discordant (those who met a White physician) visits. Satisfaction with physician visit was lower in racially discordant than racially concordant encounters. In racially concordant visits, high education was associated with higher satisfaction; however, racial discrimination was associated with lower satisfaction. In racially discordant visits ((i.e., with a White doctor), having a White friend as well as high sense of control were associated with higher satisfaction, while negative attitudes about Blacks was associated with a lower level of satisfaction. Racially concordant and discordant visits have different satisfaction levels. Racially concordant and discordant visits also have different predictors of communication satisfaction among Black patients. Socioeconomic status as well as racial attitudes and experiences impact the quality of communication of the Black patients with their doctors; however, these effects depend on the race of the doctor.
Highlights
Both socioeconomic and race-related factors both influence the quality of medical encounters, it is not known how these effects differ between racially concordant and discordant medical visits
For Black patients visiting a Black doctor, high education was associated with higher satisfaction, while perceived racial discrimination was associated with lower satisfaction
For Black patients visiting a White doctor, having a White close friend as well as high control beliefs were associated with higher satisfaction, while negative attitudes about Blacks were associated with lower communication satisfaction
Summary
Assari: Race Concordance and Communication Satisfaction of Black Patients different.[9,10,11,12,13,14] Compared to racially concordant visits, racially discordant medical interactions tend to be shorter in length,[10] less patient-centered,[11] less positive,[12] and involve fewer attempts at relationship building.[13] The White physicians have a tendency to spend less time for the following activities with Black than White patients having an informal conversation, planning treatment with the patient, providing health education, and answering to the patients’ questions.[14] For instance, White doctors are less likely to discuss the possible side effects of medications with Black than White patients.[15] White physicians use more words in the conversations with White than with Black patients.[16] Black patients with cancer are less likely than their White counterparts to receive important health communication messages in oncology settings.[17,18] Black patients have a lower tendency to get engaged in discussion and ask questions from their doctors, when their doctor is not Black.[17,18] a wide range of personal and interpersonal factors reduce likelihood of information exchange in racially discordant medical interactions.[6,7] One determinant of the quality of medical encounters is patients’ socioeconomic status (SES). Most of the previous literature is conducted in clinical settings and is often limited to a particular specialty
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