Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Jennifer Malat, PhD¹, Diana Burgess, PhD², Michelle Van Ryn, PhD³, Greta Friedemann-Sanchez, PhD², and Rose Clark-Hitt, MBA¹. (1) Sociology, University of Cincinnati, PO 210378, Dept. of Sociology, Cincinnati, OH 45221-0378, 513.556.4709, Jennifer.Malat@uc.edu, (2) Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, One Veterans Drive, Minneapolis, MN 55417, (3) School of Medicine, University of Minnesota, Rm 225, 925 Delaware Street SE, Minneapolis, MN 55414

Volumes of research demonstrate that white patients are more likely than black patients to receive a range of medical treatment—from coronary artery bypass surgery to adequate treatment of pain. In striking contrast to the quantity of studies documenting the disparity in medical treatment, there is very little research investigating health care providers' perspectives on the problem. Knowledge of healthcare providers' perspectives can assist in developing programs that can reduce the disparity.

The data come from interviews with 16 doctors and 9 nurses in two major medical centers in the upper-Midwest. The interviews average about 25 minutes in length. Respondents were asked a set of open-ended questions designed to uncover how they feel race affects patient care and why there are racial disparities in medical treatment. For the present study, the analysis is focused on how respondents explain racial inequality in medical treatment. The first focal question asked, “Recent research has shown that white patients are more likely to be referred to a specialist than a black patients. Why do you think this is?” Follow-up questions clarified research to respondents and probed beliefs further. The analysis coding scheme is based on respondents' own explanations.

Analysis shows that respondents' answers focused on three main areas: 1) whites' greater assertiveness in requesting treatment, 2) lack of access to care (e.g., insurance coverage or poverty), and 3) adherence/follow-up problems among non-white patients. This paper focuses on the explanation that whites are more “demanding.” Approximately 55% of doctors and nurses mention this explanation, often as their first response. Respondents make statements such as, “White people are more likely to demand referrals to specialists. And…have a sense of entitlement to that.”

The belief that whites' demands are a major explanation for racial inequality in medical treatment has several implications for interventions. First, this belief locates the cause of disparities in patients, not doctors. Second, this perspective contradicts notions of professional autonomy by implying that doctors have little professional control in the face of whites' demands. Third, it suggests that doctors and nurses believe that inequality results not from blacks getting too little care, but whites getting too much, which is not fully accurate. Fourth, it provides the impetus for future research on whether and how patients make demands of doctors. Fourth, it suggests that provider interventions should include strategies for managing patient demands and offering appropriate care to patients who are not assertive.

Learning Objectives:

• Describe prevalent explanations given by doctors and nurses for racial inequality in medical treatment.
• Discuss the implications of naming whites' demands as a reason for racial inequality in medical care.

Keywords: Minority Health, Providers

Presenting author's disclosure statement:

Not Answered