Doctor-Patient Communication, Cultural Competence, and Minority Health

Perloff, Richard M.; Bonder, Bette R.; Ray, George B.; Ray, Eileen Berlin; Siminoff, Laura A.

doi:10.1177/0002764205283804

Cited by 112 publications

(99 citation statements)

References 42 publications

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“…Culture influences multiple aspects of physician-patient communication, including expectations, interpersonal agendas, and assumptions. 20 The PPI checklist may inadvertently codify cultural norms specific to the dominant culture. Checklist items such as "active listening" or "establishing personal rapport" may be particularly culturally determined, although we found no evidence in our study that these items were more highly associated with student ethnicity.…”

Section: Discussionmentioning

confidence: 99%

Impact of Student Ethnicity and Primary Childhood Language on Communication Skill Assessment in a Clinical Performance Examination

et al. 2007

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BACKGROUND: Clinical performance examinations (CPX) with standardized patients (SPs) have become a preferred method to assess communication skills in US medical schools. Little is known about how trainees' backgrounds impact CPX performance. OBJECTIVE:The objective of this paper is to examine the impact of student ethnicity, primary childhood language, and experience of diversity on the communication scores of a high-stakes CPX using SPs. DESIGN:This research was designed as an observational study. PARTICIPANTS:The participants of this study were third-year medical students at one US medical school. MEASUREMENTS AND MAIN RESULTS:The measurements used in this study were CPX scores from mandatory exam, student demographics and experience with diversity measured by self-report on a survey, and Medical College Admission Test (MCAT) and United States Medical Licensing Examination (USMLE) scores. A total of 135 students participated. Asian and black students scored lower than white students on the communication portion of the CPX by approximately half a standard deviation (Asian, 67.4%; black, 64.4%; white, 69.4%, p< .05). There were no differences by ethnicity on history/ physical exam scores. Multivariate analysis controlling for MCAT verbal scores reduced ethnic differences in communication scores (Asian-white mean differences= 1.95, p=0.02), but Asian-white differences were eliminated only after sequential models included primary childhood language (difference=0.57, p=0.6).CONCLUSIONS: Even after controlling for English language knowledge as measured in MCAT verbal scores, speaking a primary childhood language other than English is associated with lower CPX communication scores for Asian students. While poorer communication skills cannot be ruled out, SP exams may contain measurement bias associated with differences in childhood language or culture. Caution is indicated when interpreting CPX communication scores among diverse examinees.

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Section: Discussionmentioning

confidence: 99%

Impact of Student Ethnicity and Primary Childhood Language on Communication Skill Assessment in a Clinical Performance Examination

et al. 2007

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“…When patients observe doctors and nurses from their own ethnic group in the hallways of hospitals, they may feel more at ease interpersonally, comfortable asking questions, trusting of Why Organizational and Community 14 recommendations, and may expect to be treated more fairly than in hospitals that are less demographically representative. These aspects of diverse patients' experiences can be associated with health-related outcomes (Perloff et al, 2006). It follows that, because demographic representativeness of hospitals increases the availability of same-ethnicity providers for patients, demographic representativeness will give rise to civility.…”

mentioning

confidence: 99%

Why Organizational and Community Diversity Matter: Representativeness and the Emergence of Incivility and Organizational Performance

King

Dawson

West

et al. 2011

AMJ

104

100

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Integrating sociological and psychological perspectives, this research considers the value of organizational ethnic diversity as a function of community diversity. Employee and patient surveys, census data, and performance indices relevant to 142 hospitals in the United Kingdom suggest that intraorganizational ethnic diversity is associated with reduced civility toward patients. However, the degree to which organizational demography was representative of the community demography was positively related to civility experienced by patients and ultimately enhanced organizational performance. These findings underscore the understudied effects of community context, and imply that intergroup biases manifested in incivility toward outgroup members hinder organizational performance. Why Organizational and Community 3 WHY ORGANIZATIONAL AND COMMUNITIY DIVERSITY MATTER: REPRESENTATIVENESS AND THE EMERGENCE OF INCIVILITY AND ORGANIZATIONAL PERFORMANCESocial, political, and technological advancements have given rise to a workforce comprised of people from a wide range of racial and ethnic backgrounds across the globe (United Nations Statistics Division, 2009). Management research on the implications of this increasing ethnic diversity has yielded mixed findings; some research within teams and dyads suggests diversity can generate innovation and breadth of information (e.g., Simmons, Pelled, & Smith, 1999), while other studies suggest diversity can have negative effects by increasing conflict and reducing cohesion (e.g., Jehn, Northcraft & Neale, 1999). The little evidence that exists at the level of the organization suggests that diversity can have positive effects on financial outcomes under some conditions (Herring, 2009;Richard, 2000;Richard, Barnett, Dwyer, & Chadwick, 2004). Researchers have therefore moved past the question of whether diversity affects outcomes and have instead begun to address the question of when and how diversity can facilitate positive outcomes (Joshi & Roh, 2009).An answer to these questions may be gleaned from one of the potential value propositions espoused by researchers and practitioners of diversity management: diverse employees may be particularly effective in serving similarly diverse populations (Richard, 2000) by bringing unique cultural sensitivity that appeals to a diverse customer base (Cox & Blake, 1991). This reasoning can be grounded in social identity and social categorization theories, which suggest that people unconsciously favor members of their own social groups (Tajfel & Turner, 1979). On its face, this rationale implies that organizational diversity will yield positive effects when it matches the demography of customers or clients the organization serves. Why Organizational and Community 4Here we suggest that the primary reason why people from one ethnic background may be less effective in serving people from other ethnic backgrounds is that the positive regard automatically afforded to ingroup members is replaced by a subtle disregard when intraorganizational diver...

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“…Medical professionals who are nervous working with the underserved populations (i.e., people of color, low income) and/or are new in their careers and lack experience interacting with these individuals may exhibit behaviors (i.e., verbal, non-verbal) that could be viewed as intentional. The verbal and non-verbal behavior communication cues act as negative enablers of health information and treatment seeking among underserved populations (Perloff, Bonder, Ray, Ray, & Siminoff, 2006).…”

Section: Discussionmentioning

confidence: 99%

Bias Within

et al. 2015

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Breast cancer mortality has affected African American women at a disproportionate rate. The purpose of this research was to assess how health professionals’ cultural competence contributes to African American women’s barriers to and receipt of mammograms. Sixty-one African American women residing in Harris County, Texas, shared their views within a series of focus groups. Theoretical propositions from the PEN-3 model were used to understand mammography adherence at the interpersonal level. Participants noted various perceived factors associated with mammography incompliance. Lack of professionalism of clinicians and clerical staff contributed to a decrease in health care services utilization. In addition, cultural insensitivity and discriminatory behavior enabled an attitude of medical mistrust. Improving patient–provider communication, through culturally appropriate centered educational efforts, is a beneficial strategy for breast health programs among underserved populations.

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Doctor-Patient Communication, Cultural Competence, and Minority Health

Cited by 112 publications

References 42 publications

Impact of Student Ethnicity and Primary Childhood Language on Communication Skill Assessment in a Clinical Performance Examination

Impact of Student Ethnicity and Primary Childhood Language on Communication Skill Assessment in a Clinical Performance Examination

Why Organizational and Community Diversity Matter: Representativeness and the Emergence of Incivility and Organizational Performance

Bias Within

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