Can patient-centered attitudes reduce racial and ethnic disparities in care?

The Institute of Medicine has concluded that racial and ethnic minorities receive lower-quality health care and have poorer health outcomes than their white counterparts in the United States.1 In addition to well-documented disparities in the technical quality of care, studies have shown that disparities exist in the quality of patient–provider communication2,3 and in the attitudes that physicians harbor towards racial/ethnic minority patients.4 As a result, health care providers have been called upon to become more patient-centered in the care they deliver and to develop cultural competence.1,5–10 Patient-centered care is considered fundamental to cultural competence and theoretically has the potential to reduce racial/ethnic disparities in health care quality, because it directly addresses many of the hypothesized mechanisms by which a patient's race/ethnicity may affect clinician behaviors.11 First, physicians have been shown to exhibit stereotyping towards patients on the basis of the patient's race/ethnicity.4,11 Although stereotyping is often unconscious, patient-centered care may reduce the occurrence of stereotyping by embracing the notion that each person should be viewed as “a unique human being.”12 Second, physicians have been found to make differential clinical decisions based on patient race.11,13 Because patient-centered care has the goal of equalizing power between patients and doctors, disparities in clinical decisions may be reduced by increasing patient involvement. Finally, physicians have shown differential interpersonal behavior, characterized by more affective distance (less warmth and empathy), when interacting with racial/ethnic minorities.3,14 Here, too, patient-centeredness places emphasis on improving these qualities of patient–physician interactions. Despite the theoretical promise of patient-centeredness to improve the quality of interpersonal relations between minority patients and their physicians,5,8 there have been no empirical studies demonstrating that a patient-centered approach reduces disparities. We have previously demonstrated that students performed more poorly during exams with African American standardized patients (SPs) than in exams with white SPs.15 The purpose of this study was to determine whether medical students who have patient-centered attitudes perform better and are less likely to demonstrate disparities in quality of care than students without patient-centered attitudes during exams with white and African American SPs.