Can patient-centered attitudes reduce racial and ethnic disparities in care?
OBJECTIVE
Patient-centeredness has been advocated to reduce racial/ethnic disparities in health care quality, but no empirical data support such a connection. The authors' purpose was to determine whether students with patient-centered attitudes have better performance and are less likely to demonstrate disparities with African American compared with white standardized patients (SPs).


METHODS
Third-year medical students were assessed by SPs at the Clinical Educational Center of the Johns Hopkins University School of Medicine in 2002. One African American and one white actor were trained as SPs for each of four case scenarios; students were randomly assigned to interact with either SP for each case. Before the exam, students were surveyed about their attitudes towards patient-centered medicine. Students with and without patient-centered attitudes were compared with regard to their performance with African American and white SPs. Outcome measures were student exam scores in interpersonal skill, history taking, physical exam, and counseling.


RESULTS
All 177 of eligible students participated in all four case scenarios. With white SPs, students with patient-centered attitudes performed similarly to students without patient-centered attitudes in all four areas. However, with African American SPs, students with patient-centered attitudes performed significantly better than students without patient-centered attitudes in interpersonal skills (71.4 versus 69.4, P = .010), history taking (63.8 versus 61.1, P = .003), and counseling (92.1 versus 88.7, P = .002) and not significantly different in physical exam performance (73.6 versus 68.6, P = .311).


CONCLUSIONS
Patient-centered attitudes may be more important in improving physician behaviors with African American patients than with white patients and may, therefore, play a role in reducing disparities.
Beach
Mary Catherine
MC
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. mcbeach@jhmi.edu
Rosner
Mary
M
Cooper
Lisa A
LA
Duggan
Patrick S
PS
Shatzer
John
J
D000328:Adult; D001741:Black or African American; D001291:Attitude of Health Personnel; D016022:Case-Control Studies; D002983:Clinical Competence; D037001:Directive Counseling; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D016544:Patient Simulation; D018802:Patient-Centered Care; D010808:Physical Examination; D010817:Physician-Patient Relations; D013337:Students, Medical / Q000523:psychology*; D044465:White People