Patients’ Beliefs About Racism, Preferences for Physician Race, and Satisfaction With Care

Dear Editor,

The article by Chen FM, Fryer GE, Phillips RL, Wilson E and Pathman DE, titled “Patients’ Beliefs About Racism, Preferences for Physician Race, and Satisfaction With Care” published in your journal (Annals of Family Medicine 2005; 3: 138-43 ), has brought out a very disturbing trend of affairs. What has a doctor do with race, ethnicity, caste, creed or sex of a patient? Are we doctors not affirming our faith to the ‘Hippocrates Oath’, or has it turned redundant in today’s world. This research reflects a study of only 3,884 individuals, out of which nearly one quarter of African Americans and one third of Latinos preferred that their personal physician was of their same race or ethnicity. If we were to extrapolate this result on the total population, it would amount to a very huge figure, which ought to be quite disconcerting to one and all.

Fostering racial suspicions and belief of discrimination as brought out in the article, does not auger well. Radical changes in the attitudes are required. We agree with the authors that the ‘sources of patients’ beliefs about racism and discrimination are deep-seated and complex and will require similarly thoughtful and multifaceted solutions’. Since ours is a shrinking world with more interracial contacts, this problem has to be addressed not merely in local terms but on a global term also. The earlier we introspect and find solutions, the better it would be for the humanity.

Regards,

1. Dr. Rajesh Chauhan

MBBS, DFM, FCGP, ADHA, FISCD

Consultant Family Medicine & Communicable Diseases.

2. Dr. Akhilesh Kumar Singh

MBBS, MD

Sr Resident Neurology

Institute of Human Behavior & Allied Sciences, Delhi.

3. Dr. Parul Kushwah

MBBS, MISCD

Family Medicine Practitioner.

Competing interests:   None declared

Acculturation and Racism

In their study investigating the link between patients’ perceived racism in their healthcare system and personal preference for physicians of concordant race and ethnicity, Chen et al raise important issues, not the least of which is the fact that some minorities perceive the healthcare system as racist. The authors, however, perhaps missed an opportunity to further shed some light on factors contributing to perceived racism in Latino subgroups. Although this survey was conducted in both English and Spanish, the Latino subgroup was not stratified by language preference. Omission of language, therefore, misses an opportunity to recognize important differences within Latino subgroups. Language is strong proxy measure of acculturation. Although in some cases higher levels of acculturation into the dominant culture in Latinos is associated with an increase in some detrimental behaviors such as drug use and poor dietary habits, acculturation marked by increased English proficiency has been shown to be associated with improved access to care and use of preventive services. (1) It is possible that limited English proficiency and its associated disenfranchisement from services in the Latino group contributes substantially to perceptions of racism. So when investigating patient’s beliefs and preferences, we should understand qualities such as acculturation that define subgroups within racial and ethnic groupings. Then we can ask ourselves not only what are the specific patient and physician qualities that contribute to perceptions of racism but also what are the factors that protect against racism in the healthcare system.

1. Lara M, et al. Acculturation and Latino Health in the united States: A Review of the literature and its Sociopolitical Context. Annual Rev Pub Health. 2005.26:367-97.

Competing interests:   None declared