Skip to main content
SpringerLink
Log in

The Patient–Physician Clinical Encounter

  • Chapter
Diversity and Inclusion in Quality Patient Care

Abstract

Certain barriers can impede opportunities to learn what matters to people and to achieve a successful clinical encounter. A multicultural physician and patient population present a dual and sometimes formidable barrier when providing appropriate and equal health care access. There is extensive study of individual and systemic barriers to positive encounters, and thus the health-care system is evolving and slowly becoming more aware of necessary ingredients for achieving successful health outcomes. We are improving, but have a long way ahead. This chapter focuses on the patient–physician encounter, factors determining its success or failure, effects on treatment decisions and health-care outcomes, and steps to develop it to an expected standard in health care. While dedicated to physicians, the information shared in this chapter is applicable to all health care professionals.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Task SAEM. Force on physician-patient communication: physician-patient communication in the emergency department. Part 2: communication strategies for specific situations. Acad Emerg Med. 1996;3:1146.

    Article  Google Scholar 

  2. Miranda Jr D, Sanchez DJ. The Tuskegee experiment: an introduction in ethics for pre-healthcare professional students. J Microbiol Biol Educ. 2014;15:232–4.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Boulware LE, Cooper LA, Ratner LE, La Veist TA, Powe NR. Race and trust in the healthcare system. Public Health Rep. 2003;118:358–65.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Gamble VN. Under the shadow of Tuskegee: African Americans and health care. Am J Public Health. 1997;87:1773–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Mansh M, Garcia G, Lunn MR. From patients to providers: changing the culture in medicine toward sexual and gender minorities. Acad Med. 2015;90:574–80.

    Article  PubMed  Google Scholar 

  6. Cleary PD, Meterko M, Wright SM, Zaslavsky AM. Are comparisons of patient experiences across hospitals fair? A study in Veterans Health Administration hospitals. Med Care. 2014;52:619–25.

    Article  PubMed  Google Scholar 

  7. Merlino J, Rice S. Getting past the ‘tribal mentality’ to improve the patient experience. Mod Healthc. 2014;44:42–3.

    PubMed  Google Scholar 

  8. Commonwealth Fund 2001 Health Care Quality Survey.

    Google Scholar 

  9. Xu KT, Borders TF, Arif AA. Ethnic differences in parents’ perception of participatory style of their children’s physicians. Med Care. 2004;42:328–35.

    Article  PubMed  Google Scholar 

  10. Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient–physician communication during medical visits. Am J Public Health. 2004;94:2084–90.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Roter DL, Hall JA. How physician gender shapes the communication and evaluation of medical care. Mayo Clin Proc. 2001;76:673–6.

    Article  CAS  PubMed  Google Scholar 

  12. Boulware LE, Ratner LE, Cooper LA, Sosa JA, LaVeist TA, Powe NA. Understanding disparities in donor behavior: race, and gender differences in willingness to donate blood and cadaveric organs. Med Care. 2002;40:85–95.

    Article  PubMed  Google Scholar 

  13. The Kaiser Family Foundation National Survey of Physicians. Part 1: doctors on disparities in medical care (2002).

    Google Scholar 

  14. Saha S, Arbelaez JJ, Cooper LA. Patient-physician relationships and racial disparities in the quality of healthcare. Am J Public Health. 2003;94:1713–9.

    Article  Google Scholar 

  15. Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in healthcare. Institute of Medicine. 2002.

    Google Scholar 

  16. Pacheco CM, Daley SM, Brown T, Filippi M, Greiner KA, Daley CM. Moving forward: breaking the cycle of mistrust between American Indians and researchers. Am J Public Health. 2013;103:2152–9.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Waseem M, Ryan M. “Doctor” or “doctora”: do patients care? Pediatr Emer Care. 2005;205:515–7.

    Article  Google Scholar 

  18. Park ER, Chun MB, Betancourt JR, Green AR, Weissman JS. Measuring residents’ perceived preparedness and skillfulness to deliver cross-cultural care. J Gen Intern Med. 2009;24:1053–6.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Green AR, Betancourt JR, Park ER, Greer JA, Donahue EJ, Weissman JS. Providing culturally competent care: residents in HRSA Title VII funded residency programs feel better prepared. Acad Med. 2008;83:1071–9.

    Article  PubMed  Google Scholar 

  20. Green AR, Miller E, Krupat E, White A, Taylor WC, Hirsh DA, et al. Designing and implementing cultural competence OSCE: lessons learned from interviews with medical students. Ethn Dis. 2007;17:344–50.

    PubMed  Google Scholar 

  21. Lopez L, Vranceanu AM, Cohen AP, Betancourt J, Weissman JS. Personal characteristics associated with resident physicians’ self perceptions of preparedness to deliver cross-cultural care. J Gen Intern Med. 2008;23:1953–8.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Park ER, Betancourt JR, Miller E, Nathan M, MacDonald E, Ananeh-Firempong 2nd O, et al. Internal medicine residents’ perceptions of cross-cultural training. Barriers, needs, and educational recommendations. J Gen Intern Med. 2006;21:476–80.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Kumagal AK, Lypson ML. Beyond cultural competence: critical consciousness, social justice and multicultural education. Acad Med. 2009;84:782–7.

    Article  Google Scholar 

  24. Hamilton G, Marco CA. Emergency medicine education and health care disparities. Acad Emerg Med. 2003;10:1189.

    Article  PubMed  Google Scholar 

  25. Hobgood C, Sawning S, Bowen J, Savage K. Teaching culturally appropriate care: a review of educational models and methods. Acad Emerg Med. 2006;13:1288.

    Article  PubMed  Google Scholar 

  26. Flores G. Providing culturally competent pediatric care: integrating pediatricians, institutions, families, and communities into the process. J Pediatr. 2003;143:1.

    Article  PubMed  Google Scholar 

  27. Scott CJ, Martin M, Hamilton G. Training of medical professionals and the delivery of health care as related to cultural identity groups. Acad Emerg Med. 2003;10:1149.

    Article  PubMed  Google Scholar 

  28. Ko M, Heslin KC, Edelstein RA, Grumbach K. The role of medical education in reducing health care disparities: the first ten years of the UCLA/Drew Medical Education Program. J Gen Intern Med. 2007;22:625–31.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Dhaliwal JS, Crane LA, Valley MA, Lowenstein SR. Student perspectives on the diversity climate at a U.S. medical school: the need for a broader definition of diversity. BMC Res Notes. 2013;6:154.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Cooper LA, Beach MC, Johnson RL, Inui TS. Delving below the surface. Understanding how race and ethnicity influence relationships in Health Care. J Gen Intern Med. 2006;21 Suppl 1:S21–7. Review.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Powe NR, Cooper LA. Disparities in patient experiences, health care processes, and outcomes: The role of patient-provider racial, ethnic, and language concordance [Internet]. 2004. Available from: http://www.commonwealthfund.org/publications/fund-reports/2004/jul/disparities-in-patient-experiences--health-care-processes--and-outcomes--the-role-of-patient-provide

  32. Lin X, Guan J. Patient satisfaction and referral intention: effect of patient-physician match on ethnic origin and cultural similarity. Health Mark Q. 2002;20:49–68.

    Article  PubMed  Google Scholar 

  33. Street Jr RL, O’Malley KJ, Cooper LA, Haidet P. Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity. Ann Fam Med. 2008;6(3):198–205.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Persky S, Kaphingst KA, Allen Jr VC, Senay I. Effects of patient-provider race concordance and smoking status on lung cancer risk perception accuracy among African-Americans. Ann Behav Med. 2013;45(3):308–17.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Johnson Thornton RL, Powe NR, Roter D, Cooper LA. Patient-physician social concordance, medical visit communication and patients’ perceptions of health care quality. Patient Educ Couns. 2011;85(3):e201–8. doi:10.1016/j.pec.2011.07.015.

    Article  PubMed Central  Google Scholar 

  36. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;11:907–15.

    Article  Google Scholar 

  37. Arguete MS, Roberts CA. Participants’ ratings of male physicians who vary in race and communication style. Psychol Rep. 2002;91:793–806.

    Article  Google Scholar 

  38. Suarez-Almazor ME. Patient-physician communication. Curr Opin Rheumatol. 2004;16:91–5.

    Article  PubMed  Google Scholar 

  39. Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004;27:237–51.

    Article  CAS  PubMed  Google Scholar 

  40. American Medical Association. Patient-centered communication [cited 2015 February 2]. Chicago, IL: American Medical Association; c 1995-2015. Available from: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/the-ethical-force-program/patient-centered-communication.

  41. Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19(2):101–10.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Haider AH, Sexton J, Sriram N, Cooper LA, Efron DT, Swoboda S, et al. Association of unconscious race and social class bias with vignette-based clinical assessments by medical students. JAMA. 2011;306:942–51.

    CAS  PubMed Central  PubMed  Google Scholar 

  43. Cone DC, Richardson LD, Todd KH, Betancourt JR, Lowe RA. Health care disparities in emergency medicine. Acad Emerg Med. 2003;10:1176.

    Article  PubMed  Google Scholar 

  44. Cohen JJ. Disparities in health care: an overview. Acad Emerg Med. 2003;10:1155.

    Article  PubMed  Google Scholar 

  45. Todd KH, Samaroo N, Hoffman JR. The effect of ethnicity on physician estimates of pain severity in patients with isolated extremity trauma. JAMA. 1994;271:925.

    Article  CAS  PubMed  Google Scholar 

  46. Todd KH, Deaton C, D’Adamo AP, Goe L. Ethnicity and analgesic practice. Ann Emerg Med. 2000;35:11.

    Article  CAS  PubMed  Google Scholar 

  47. Bazarian JJ, Pope C, McClung J, Cheng YT, Flesher W. Ethnic and racial disparities in emergency department care for mild traumatic brain injury. Acad Emerg Med. 2003;10:1209.

    Article  PubMed  Google Scholar 

  48. Wall SP, Ha ES, Habicht ME, Wawda H, Merchant GL, Ettner SL, et al. Impact of patient race on receiving heat CT during blunt head injury evaluation. Acad Emerg Med. 2005;12:862.

    Article  PubMed  Google Scholar 

  49. Harris B, Hwang U, Richardson LD, Lee W. Disparities in computed tomography utilization for adult patients presenting to the emergency department with headache. Ann Emerg Med. 2007;50:S120.

    Article  Google Scholar 

  50. Richardson LD, Irvin CB, Tamayo-Sarver JH. Racial and ethnic disparities in the practice of emergency medicine. Acad Emerg Med. 2003;10:1184.

    Article  PubMed  Google Scholar 

  51. James TL, Feldman J, Mehta SD. Physician variability in history taking when evaluating patients presenting with chest pain in the emergency department. Acad Emerg Med. 2006;13:147.

    Article  PubMed  Google Scholar 

  52. van Ryn M, Burke J. The effects of race and socioeconomic status on physicians’ perceptions of patients. Soc Sci Med. 2000;50:813.

    Article  PubMed  Google Scholar 

  53. Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28(11):1504–10.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, Iezzoni LI, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231–8.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Sewell JL, Velayos FS. Systematic review: the role of race and socioeconomic factors on IBD healthcare delivery and effectiveness. Inflamm Bowel Dis. 2013;19:627–43.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Mississippi Public Broadcasting Radio. Racial bias in health care: an interview with Dr. Claudia Fegan [Internet]. 2013. Chicago, IL: Physicians for National Health Program; c 2015. [cited 2015 February 6]. Available from: http://www.pnhp.org/news/2013/may/racial-bias-in-health-care-an-interview-with-dr-claudia-fegan .

  57. Corbin TJ, Rich JA, Bloom SL, Delgado D, Rich LJ, Wilson AS. Developing a trauma-informed, emergency department-based intervention for victims of urban violence. J Trauma Dissociation. 2011;12:510–25.

    Article  PubMed  Google Scholar 

  58. Cunningham R, Knox L, Fein J, Harrison S, Frisch K, Walton M, et al. Before and after the trauma bay: the prevention of violent injury among youth. Ann Emerg Med. 2009;53:490–500.

    Article  PubMed  Google Scholar 

  59. Becker MG, Hall JS, Ursic CM, Jain S, Calhoun D. Caught in the crossfire: the effects of a peer-based intervention program for violently injured youth. J Adolesc Health. 2004;34:177–83.

    Article  PubMed  Google Scholar 

  60. Cheng TL, Haynie D, Brenner R, Wright JL, Chung S, Simons-Morton B. Effectiveness of a mentor-implemented, violence prevention intervention for assault-injured youths presenting to the emergency department: Results of a randomized trial. Pediatrics. 2008;122:938–46.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Fein JA, Kassam-Adams N, Gavin M, Huang R, Blanchard D, Datner EM. Persistence of posttraumatic stress in violently injured youth seen in the emergency department. Arch Pediatr Adolesc Med. 2002;156:836–40.

    Article  PubMed  Google Scholar 

  62. Ketterlinus RD, editor. Youth violence: Interventions for health care providers. Washington, DC: The American Public Health Association; 2008.

    Google Scholar 

  63. Purtle J, Dicker R, Cooper C, Corbin T, Greene MB, Marks A, et al. Hospital-based violence intervention programs save lives and money. J Trauma Acute Care Surg. 2013;75:331–3.

    Article  PubMed  Google Scholar 

  64. Shibru D, Zahnd E, Becker M, Bekaert N, Calhoun D, Victorino GP. Benefits of a hospital-based peer intervention program for violently injured youth. J Am Coll Surg. 2007;205:684–9.

    Article  PubMed  Google Scholar 

  65. James TL, Bibi S, Langlois BK, Elizabeth Dugan E, Mitchell PM. Boston violence intervention advocacy program: a qualitative study of client experiences and perceived effect. Acad Emerg Med. 2014;21(7):742–51. doi:10.1111/acem.12409.

    Article  PubMed  Google Scholar 

  66. Thornton TN, Craft CA, Dahlberg LL, Lynch BS, Baer K (eds). Best practices of youth violence prevention: A sourcebook for community action. [Internet]. Atlanta, GA: CDC; 2002 [cited 2013 Aug 1]. Available from: http://www.cdc.gov/violenceprevention/pub/yv_bestpractices.html.

  67. United States Department of Justice. Report of the Attorney General’s national task force on children exposed to violence [Internet]. 2012 [cited 2013 Aug 1]. Available from: http://www.justice.gov/defendingchildhood/cev-rpt-full.pdf.

  68. Karraker N, Cunningham RM, Becker MG, Fein JA, Knox LM. Violence is preventable: A best practices guide for launching and sustaining a hospital-based program to break the cycle of violence. Replication Guide was produced by Youth ALIVE! under grant # 2009-SZ-B9-K004, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. 2011 [cited 2013 Sept 23]. Available from: http://youthalive1.squarespace.com/storage/ViolenceisPreventableOnline.pdf.

  69. Cheng TL, Schwarz D, Brenner RA, Wright JL, Fields CB, O’Donnell R, et al. Adolescent assault injury: risk and protective factors and locations of contact for intervention. Pediatrics. 2003;112:931–8.

    Article  PubMed  Google Scholar 

  70. Cooper C, Eslinger D, Nash D, al-Zawahri J, Stolley P. Repeat victims of violence: report of a large concurrent case-control study. Arch Surg. 2000;135:837–43.

    Article  CAS  PubMed  Google Scholar 

  71. National Center for Trauma Informed Care. Models for developing trauma-informed behavioral health systems and trauma-specific service [Internet]. 2008 [cited 2013 Dec 4]. Available from: www.uwgb.edu/bhtp/tools/developing_trauma.

  72. National Center for Trauma Informed Care. Report of project activities over the past 18 months, history, and selected products [Internet]. 2012 Mar 26 [cited 2013 Dec 4] Available from: http://www.nasmhpd.org/docs/NCTIC/NCTIC_Final_Report_3-26-12.pdf.

  73. Kilpatrick DG, Acierno R, Saunders B, Resnick HS, Best C, Schnurr PP. Risk factors for adolescent substance abuse and dependence: data from a national sample. J Consult Clin Psychol. 2000;68:19–30.

    Article  CAS  PubMed  Google Scholar 

  74. National Network of Hospital-Based Violence Intervention Programs. Available from: www.nnhvip.org

  75. Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49:796–804.

    CAS  PubMed  Google Scholar 

  76. Saha S, Beach MC, Cooper LA. Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc. 2008;100:1275–85.

    PubMed Central  PubMed  Google Scholar 

  77. Hearld LR, Alexander JA. Patient-centered care and emergency department utilization: a path analysis of the mediating effects of care coordination and delays in care. Med Care Res Rev. 2012;69(5):560–80.

    Article  PubMed  Google Scholar 

  78. Beach MC, Saha S, Cooper LA. The role and relationship of cultural competence and patient-centeredness in health care quality [Internet]. 2006 [cited 2015 Feb 5]. Washington, DC: The Commonwealth Fund; c 2015. Available from: www.commonwealthfund.org/usr_doc/Beach_rolerelationshipcultcomppatient-cent_960.pdf

  79. Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med. 2011;24(3):229–3.

    Article  PubMed  Google Scholar 

  80. Rickert J. Patient centered-care: What it means and how to get there. 2012. Health Affairs blog [Internet]. Millwood, VA: Project HOPE; c 1995-2015. [cited 2015 January 12]. Available from: http://healthaffairs.org/blog/2012/01/24/patient-centered-care-what-it-means-and-how-to-get-there/.

  81. Kane GC, Gotto JL, Mangione S, West S, Hojat M. Jefferson scale of patient’s perceptions of physician empathy: preliminary psychometric data. Croat Med J. 2007;48:81–6.

    PubMed Central  PubMed  Google Scholar 

  82. National Standards for Culturally and Linguistically Appropriate Services in Health Care. Final report. Washington, DC: U.S. Department of Health and Human Services, Office of Minority Health; 2001. [cited 2015 February 2015]. Available from: http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf

  83. Massachusetts Division of Medical Assistance: Appendix G: Cultural Competence QIP Reporting. Boston: Division of Medical Assistance; 1997.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Emergency Department, Boston Medical Center, Boston, MA, USA

    Thea James M.D.

Authors
  1. Thea James M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thea James M.D. .

Editor information

Editors and Affiliations

  1. Professor of Emergency Medicine University of Virginia School of Medicine Department of Emergency Medicine, Vice President and Chief Officer for Diversity and Equity, Charlottesville, Virginia, USA

    Marcus L. Martin

  2. Assistant Dean Clinical Education & Student Affairs Emory University School of Medicine, Professor of Emergency Medicine Vice Chair – Administrative Affairs, Atlanta, Georgia, USA

    Sheryl L. Heron

  3. Director of Diversity Department of Medicine Section of Emergency Medicine Louisiana State University Health Sciences Center - New Orleans, Professor of Emergency Medicine Director of Research, New Orleans, Louisiana, USA

    Lisa Moreno-Walton

  4. University of Virginia Hospital, Charlottesville, Virginia, USA

    Anna Walker Jones

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

James, T. (2016). The Patient–Physician Clinical Encounter. In: Martin, M., Heron, S., Moreno-Walton, L., Jones, A. (eds) Diversity and Inclusion in Quality Patient Care. Springer, Cham. https://doi.org/10.1007/978-3-319-22840-2_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-22840-2_7

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22839-6

  • Online ISBN: 978-3-319-22840-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation