"It's not what you say ..."

Racial disparities in communication between orthopedic surgeons and patients

Wendy Levinson, Pamela L. Hudak, Jacob J. Feldman, Richard Frankel, Alma Kuby, Sylvia Bereknyei, Clarence Braddock

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

BACKGROUND:: Excellent communication between surgeons and patients is critical to helping patients to make informed decisions and is a key component of both high quality of care and patient satisfaction. Understanding racial disparities in communication is essential to provide quality care to all patients. OBJECTIVE:: To examine the content and process of informed decision-making (IDM) between orthopedic surgeons and elderly white versus African American patients. To assess the association of race and patient satisfaction with surgeon communication. RESEARCH DESIGN:: Analysis of audiotape recordings of office visits between orthopedic surgeons and patients. PARTICIPANTS:: Eighty-nine orthopedic surgeons and 886 patients age 60 years or older in Chicago, Illinois. METHODS:: Tapes were analyzed by coders for content using 9 elements of IDM and for process using 4 global ratings of the relationship-building component of communication (responsiveness, respect, listening, and sharing). Ratings by race were compared using χ analysis. Patients completed a questionnaire rating satisfaction with surgeon communication and the visit overall. Logistic analysis was used to assess the effect of race on satisfaction. RESULTS:: Overall there were practically no significant differences in the content of the 9 IDM elements based on race. However, coder ratings of relationship were higher on 3 of 4 global ratings (responsiveness, respect, and listening) in visits with white patients compared with African American patients (P < 0.01). Patient ratings of communication and overall satisfaction with the visit were significantly higher for white patients. CONCLUSIONS:: The content of IDM conversations does not differ by race. Yet differences in the process of relationship building and in patient satisfaction ratings were clearly present. Efforts to enhance cultural communication competence of surgeons should emphasize the skills of building relationships with patients in addition to the content of IDM.

Original languageEnglish
Pages (from-to)410-416
Number of pages7
JournalMedical Care
Volume46
Issue number4
DOIs
StatePublished - Apr 2008

Fingerprint

rating
Communication
communication
decision making
Decision Making
Patient Satisfaction
respect
Quality of Health Care
African Americans
Orthopedic Surgeons
recording
Tape Recording
conversation
Cultural Competency
Office Visits
logistics
questionnaire
Surgeons
American

Keywords

  • Communication
  • Physician-patient relationship
  • Racial disparities

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

"It's not what you say ..." : Racial disparities in communication between orthopedic surgeons and patients. / Levinson, Wendy; Hudak, Pamela L.; Feldman, Jacob J.; Frankel, Richard; Kuby, Alma; Bereknyei, Sylvia; Braddock, Clarence.

In: Medical Care, Vol. 46, No. 4, 04.2008, p. 410-416.

Research output: Contribution to journalArticle

Levinson, Wendy ; Hudak, Pamela L. ; Feldman, Jacob J. ; Frankel, Richard ; Kuby, Alma ; Bereknyei, Sylvia ; Braddock, Clarence. / "It's not what you say ..." : Racial disparities in communication between orthopedic surgeons and patients. In: Medical Care. 2008 ; Vol. 46, No. 4. pp. 410-416.
@article{1b15da75159242e38e08ca8c3c3889cb,
title = "{"}It's not what you say ...{"}: Racial disparities in communication between orthopedic surgeons and patients",
abstract = "BACKGROUND:: Excellent communication between surgeons and patients is critical to helping patients to make informed decisions and is a key component of both high quality of care and patient satisfaction. Understanding racial disparities in communication is essential to provide quality care to all patients. OBJECTIVE:: To examine the content and process of informed decision-making (IDM) between orthopedic surgeons and elderly white versus African American patients. To assess the association of race and patient satisfaction with surgeon communication. RESEARCH DESIGN:: Analysis of audiotape recordings of office visits between orthopedic surgeons and patients. PARTICIPANTS:: Eighty-nine orthopedic surgeons and 886 patients age 60 years or older in Chicago, Illinois. METHODS:: Tapes were analyzed by coders for content using 9 elements of IDM and for process using 4 global ratings of the relationship-building component of communication (responsiveness, respect, listening, and sharing). Ratings by race were compared using χ analysis. Patients completed a questionnaire rating satisfaction with surgeon communication and the visit overall. Logistic analysis was used to assess the effect of race on satisfaction. RESULTS:: Overall there were practically no significant differences in the content of the 9 IDM elements based on race. However, coder ratings of relationship were higher on 3 of 4 global ratings (responsiveness, respect, and listening) in visits with white patients compared with African American patients (P < 0.01). Patient ratings of communication and overall satisfaction with the visit were significantly higher for white patients. CONCLUSIONS:: The content of IDM conversations does not differ by race. Yet differences in the process of relationship building and in patient satisfaction ratings were clearly present. Efforts to enhance cultural communication competence of surgeons should emphasize the skills of building relationships with patients in addition to the content of IDM.",
keywords = "Communication, Physician-patient relationship, Racial disparities",
author = "Wendy Levinson and Hudak, {Pamela L.} and Feldman, {Jacob J.} and Richard Frankel and Alma Kuby and Sylvia Bereknyei and Clarence Braddock",
year = "2008",
month = "4",
doi = "10.1097/MLR.0b013e31815f5392",
language = "English",
volume = "46",
pages = "410--416",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - "It's not what you say ..."

T2 - Racial disparities in communication between orthopedic surgeons and patients

AU - Levinson, Wendy

AU - Hudak, Pamela L.

AU - Feldman, Jacob J.

AU - Frankel, Richard

AU - Kuby, Alma

AU - Bereknyei, Sylvia

AU - Braddock, Clarence

PY - 2008/4

Y1 - 2008/4

N2 - BACKGROUND:: Excellent communication between surgeons and patients is critical to helping patients to make informed decisions and is a key component of both high quality of care and patient satisfaction. Understanding racial disparities in communication is essential to provide quality care to all patients. OBJECTIVE:: To examine the content and process of informed decision-making (IDM) between orthopedic surgeons and elderly white versus African American patients. To assess the association of race and patient satisfaction with surgeon communication. RESEARCH DESIGN:: Analysis of audiotape recordings of office visits between orthopedic surgeons and patients. PARTICIPANTS:: Eighty-nine orthopedic surgeons and 886 patients age 60 years or older in Chicago, Illinois. METHODS:: Tapes were analyzed by coders for content using 9 elements of IDM and for process using 4 global ratings of the relationship-building component of communication (responsiveness, respect, listening, and sharing). Ratings by race were compared using χ analysis. Patients completed a questionnaire rating satisfaction with surgeon communication and the visit overall. Logistic analysis was used to assess the effect of race on satisfaction. RESULTS:: Overall there were practically no significant differences in the content of the 9 IDM elements based on race. However, coder ratings of relationship were higher on 3 of 4 global ratings (responsiveness, respect, and listening) in visits with white patients compared with African American patients (P < 0.01). Patient ratings of communication and overall satisfaction with the visit were significantly higher for white patients. CONCLUSIONS:: The content of IDM conversations does not differ by race. Yet differences in the process of relationship building and in patient satisfaction ratings were clearly present. Efforts to enhance cultural communication competence of surgeons should emphasize the skills of building relationships with patients in addition to the content of IDM.

AB - BACKGROUND:: Excellent communication between surgeons and patients is critical to helping patients to make informed decisions and is a key component of both high quality of care and patient satisfaction. Understanding racial disparities in communication is essential to provide quality care to all patients. OBJECTIVE:: To examine the content and process of informed decision-making (IDM) between orthopedic surgeons and elderly white versus African American patients. To assess the association of race and patient satisfaction with surgeon communication. RESEARCH DESIGN:: Analysis of audiotape recordings of office visits between orthopedic surgeons and patients. PARTICIPANTS:: Eighty-nine orthopedic surgeons and 886 patients age 60 years or older in Chicago, Illinois. METHODS:: Tapes were analyzed by coders for content using 9 elements of IDM and for process using 4 global ratings of the relationship-building component of communication (responsiveness, respect, listening, and sharing). Ratings by race were compared using χ analysis. Patients completed a questionnaire rating satisfaction with surgeon communication and the visit overall. Logistic analysis was used to assess the effect of race on satisfaction. RESULTS:: Overall there were practically no significant differences in the content of the 9 IDM elements based on race. However, coder ratings of relationship were higher on 3 of 4 global ratings (responsiveness, respect, and listening) in visits with white patients compared with African American patients (P < 0.01). Patient ratings of communication and overall satisfaction with the visit were significantly higher for white patients. CONCLUSIONS:: The content of IDM conversations does not differ by race. Yet differences in the process of relationship building and in patient satisfaction ratings were clearly present. Efforts to enhance cultural communication competence of surgeons should emphasize the skills of building relationships with patients in addition to the content of IDM.

KW - Communication

KW - Physician-patient relationship

KW - Racial disparities

UR - http://www.scopus.com/inward/record.url?scp=41149144052&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=41149144052&partnerID=8YFLogxK

U2 - 10.1097/MLR.0b013e31815f5392

DO - 10.1097/MLR.0b013e31815f5392

M3 - Article

VL - 46

SP - 410

EP - 416

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 4

ER -