OBJECTIVE:To determine the effect of limited English proficiency on medical comprehension in the presence and absence of language-concordant physicians. DESIGN, SETTING, AND PARTICIPANTS:A telephone survey of 1,200 Californians was conducted in 11 languages. The survey included 4 items on medical comprehension: problems understanding a medical situation, confusion about medication use, trouble understanding labels on medication, and bad reactions to medications. Respondents were also asked about English proficiency and whether their physicians spoke their native language. MEASUREMENTS AND MAIN RESULTS:We analyzed the relationship between English proficiency and medical comprehension using multivariate logistic regression. We also performed a stratified analysis to explore the effect of physician language concordance on comprehension. Forty-nine percent of the 1,200 respondents were defined as limited English proficient (LEP). Limited English-proficient respondents were more likely than English-proficient respondents to report problems understanding a medical situation (adjusted odds ratio [AOR] 3.2/confidence interval [CI] 2.1, 4.8), trouble understanding labels (AOR 1.5/CI 1.0, 2.3), and bad reactions (AOR 2.3/CI 1.3, 4.4). Among respondents with language-concordant physicians, LEP respondents were more likely to have problems understanding a medical situation (AOR 2.2/CI 1.2, 3.9). Among those with language-discordant physicians, LEP respondents were more likely to report problems understanding a medical situation (AOR 9.4/CI 3.7, 23.8), trouble understanding labels (AOR 4.2/CI 1.7, 10.3), and bad medication reactions (AOR 4.1/CI 1.2, 14.7).CONCLUSION: Limited English proficiency is a barrier to medical comprehension and increases the risk of adverse medication reactions. Access to language-concordant physicians substantially mitigates but does not eliminate language barriers. and patient recall. 32The current literature, however, has been limited by recruitment in patient care settings, relatively small sample sizes, and inclusion of few languages other than Spanish. The broader impact of language barriers on patient comprehension and the associated effects of access to language-concordant physicians remain unexplored. The goal of this study was to investigate the effects of language barriers in a linguistically diverse population-based sample, determine the extent to which limited English proficiency contributes to difficulty with medical comprehension, and explore the effects of languageconcordant physicians on comprehension.

PURPOSE Few studies have attempted to link patients' beliefs about racism in the health care system with how they use and experience health care.METHODS Using telephone survey data from a national sample of 1,479 whites, 1,189 African Americans, and 983 Latinos, we explored patients' beliefs about racism, their preferences for the race and ethnicity of their physician, and their satisfaction with that physician. A scale was developed to refl ect patients' beliefs about racism. Race-stratifi ed analyses assessed associations between patients' beliefs, racial preferences for physicians, choice of physician, and satisfaction with care.RESULTS Among African Americans, stronger beliefs about racial discrimination in health care were associated with preferring an African American physician (P <.001). Whereas only 22% of African Americans preferred an African American physician, those who preferred a African American physician and had an African American physician were more likely to rate their physician as excellent than did African Americans who preferred a African American physician but had a non-African American physician (57% vs 20%, P <.001). Latinos with stronger beliefs about discrimination in health care were more likely to prefer a Latino physician (P <.001). One third of Latinos preferred a Latino physician. Though not statistically signifi cant, those who preferred and had a Latino physician rated their physician higher than Latinos who preferred a Latino physician but had a non-Latino physician (40% vs 29%).CONCLUSIONS Many African Americans and Latinos perceive racism in the health care system, and those who do are more likely to prefer a physician of their own race or ethnicity. African Americans who have preferences are more often satisfi ed with their care when their own physicians match their preferences. INTRODUCTIONR acial and ethnic disparities are a major problem in the US health care system. 1 Racial differences have been documented in access to care, receipt of needed medical care, preventive services, and lifesaving technologies. [2][3][4][5][6][7] There is, however, considerable uncertainty around the factors that contribute to racial disparities in health care.8 Although disparities can be explained in part by differences in access to care, socioeconomic conditions, or even bias from health care physicians, the role of patients' beliefs and preferences remains unclear. 9,10 What is the connection between patients' racial beliefs and biases and their preferences for the race of their health caregivers? Shared language, social experiences, and cultural beliefs may drive some preferences. 4,11,12 At the same time, the dubious experience of American medical research in minorities has fostered racial suspicions among some groups. 13 14-16 Although some have documented patients' preferences for clinicians of the same race and a subsequent association with patient satisfaction, the factors that contribute to patients' preferences remain unclear. [15][16][17][18][19][20][21][22] Using a nat...

Purpose To examine the perceptions and experiences of ethnic minority faculty at University of California–San Francisco regarding racial and ethnic diversity in academic medicine, in light of a constitutional measure outlawing race- and gender-based affirmative action programs by public universities in California. Method In 2005, underrepresented minority faculty in the School of Medicine at University of California–San Francisco were individually interviewed to explore three topics: participants’ experiences as minorities, perspectives on diversity and discrimination in academic medicine, and recommendations for improvement. Interviews were tape-recorded, transcribed verbatim, and subsequently coded using principles of qualitative, text-based analysis in a four-stage review process. Results Thirty-six minority faculty (15 assistant professors, 11 associate professors, and 10 full professors) participated, representing diversity across specialties, faculty rank, gender, and race/ethnicity. Seventeen were African American, 16 were Latino, and 3 were Asian. Twenty participants were women. Investigators identified four major themes: (1) choosing to participate in diversity-related activities, driven by personal commitment and institutional pressure, (2) the gap between intention and implementation of institutional efforts to increase diversity, (3) detecting and reacting to discrimination, and (4) a need for a multifaceted approach to mentorship, given few available minority mentors. Conclusions Minority faculty are an excellent resource for identifying strategies to improve diversity in academic medicine. Participants emphasized the strong association between effective mentorship and career satisfaction, and many delineated unique mentoring needs of minority faculty that persist throughout academic ranks. Findings have direct application to future institutional policies in recruitment and retention of underrepresented minority faculty.