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Lisa Cooper-Patrick, MD, MPH; Joseph J. Gallo, MD, MPH; Junius J. Gonzales, MD; Hong Thi Vu, MHS; Neil R. Powe, MD, MPH, MBA; Christine Nelson, RN; Daniel E. Ford, MD, MPH

JAMA. 1999;282:583-589.

Context  Many studies have documented race and gender differences in health care received by patients. However, few studies have related differences in the quality of interpersonal care to patient and physician race and gender.

Objective  To describe how the race/ethnicity and gender of patients and physicians are associated with physicians' participatory decision-making (PDM) styles.

Design, Setting, and Participants  Telephone survey conducted between November 1996 and June 1998 of 1816 adults aged 18 to 65 years (mean age, 41 years) who had recently attended 1 of 32 primary care practices associated with a large mixed-model managed care organization in an urban setting. Sixty-six percent of patients surveyed were female, 43% were white, and 45% were African American. The physician sample (n=64) was 63% male, with 56% white, and 25% African American.

Main Outcome Measure  Patients' ratings of their physicians' PDM style on a 100-point scale.

Results  African American patients rated their visits as significantly less participatory than whites in models adjusting for patient age, gender, education, marital status, health status, and length of the patient-physician relationship (mean [SE] PDM score, 58.0 [1.2] vs 60.6 [3.3]; P=.03). Ratings of minority and white physicians did not differ with respect to PDM style (adjusted mean [SE] PDM score for African Americans, 59.2 [1.7] vs whites, 61.7 [3.1]; P=.13). Patients in race-concordant relationships with their physicians rated their visits as significantly more participatory than patients in race-discordant relationships (difference [SE], 2.6 [1.1]; P=.02). Patients of female physicians had more participatory visits (adjusted mean [SE] PDM score for female, 62.4 [1.3] vs male, 59.5 [3.1]; P=.03), but gender concordance between physicians and patients was not significantly related to PDM score (unadjusted mean [SE] PDM score, 76.0 [1.0] for concordant vs 74.5 [0.9] for discordant; P=.12). Patient satisfaction was highly associated with PDM score within all race/ethnicity groups.

Conclusions  Our data suggest that African American patients rate their visits with physicians as less participatory than whites. However, patients seeing physicians of their own race rate their physicians' decision-making styles as more participatory. Improving cross-cultural communication between primary care physicians and patients and providing patients with access to a diverse group of physicians may lead to more patient involvement in care, higher levels of patient satisfaction, and better health outcomes.

Author Affiliations: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md (Drs Cooper-Patrick, Gallo, Powe, and Ford and Ms Vu); Department of Health Policy and Management (Drs Cooper-Patrick, Powe, and Ford) and Department of Mental Hygiene (Dr Gallo), Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md; Department of Psychiatry, Georgetown University Medical Center, Washington, DC (Dr Gonzales); and NYLCare Health Plans of the Mid-Atlantic, Greenbelt, Md (Ms Nelson).

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