The Washington Post, the Henry J. Kaiser Family Foundation and Harvard University Racial Attitudes Survey (April 2001)
6
Unfair Treatment
12
Trust and
Patient Satisfaction
• Patients with 95th percentile trust scores
were about 5 times more likely than those
with median levels of trust to express
complete satisfaction with their physician.
(Safran et al. 1998)
• Thom et al. (1999) found trust to be a
significant predictor of patient‘s
satisfaction with care received from their
physician.
13
Trust:
Mediator of the Placebo Effect?
15
Trust:
Interpersonal Institutional
Trust in the medical profession can be:
• Interpersonal: Patients trusting their physicians,
health care professionals.
• Institutional: Patients trusting their hospital, clinic,
or the medical profession.
(Mechanic and Schlesinger 1996)
Interpersonal and Institutional trust are related:
• Beginning a relationship with a new physician
requires some level of institutional trust.
• Institutional trust can be cultivated by building on
existing trust between patients and physicians.
16
American Minorities
Have Less Trust
• Interpersonal Trust
– Whites generally have higher levels of trust in
their physicians (Kao 1998)
– Trust scores are especially low for Latino and
African American men (Doescher 2000)
– When asked if they trust their primary
nephrologists' judgment about their medical care
African Americans responded ―somewhat‖ or ―not
at all‖ more often than whites (men 22% vs. 12%,
women 24% Vs 11%). (Ayanian 1999)
• Still, most patients trust their own physician a great
deal.
17
Less Institutional Trust
• Major Differences
– African American men and women are less trusting of
hospitals. (Boulware 2002)
– African Americans are less trusting of the reasons
physicians use or withdraw life sustaining therapies.
(Hauser 1997, Blackhall 1999)
– African Americans are less trusting of the organ donation
system. (Yuen 1998, Siminoff 1999)
– African Americans have less trust in the health care
system in general. (Gamble 1997, Freedman 1998, Minniefield 2001)
– African Americans have profound mistrust of medical
research. (Freedman 1998, Freimuth 2001, Shavers 2001, Corbie-
Smith 1999 and 2002)
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Trust vs. Trustworthiness
19
Extreme Mistrust
• The government introduced drugs into African American
communities.
• AIDS/HIV is a man made form of genocide.
• African Americans are used as guinea pigs in medical
experiments.
• Physicians withdraw life-support to African Americans for
financial/racial reasons over medical reasons.
• Gamble 1997, Freedman 1998, Freimuth 2001
• ―They treat us like guinea pigs. They are trying stuff out on us -
stuff they learned in school.‖ (Corbie-Smith 1999)
21
HIV & Genocide
• The AIDS virus was ―deliberately created in a laboratory in order
to infect black people.‖ (NY Times/WCBS Poll 1990)
– Believed to be true by 10% of African Americans
– Believed might be true by another 20%
• AZT is a plot to poison African American people.
• Urging condom use is a scheme to prevent African American
births.
• Distributing clean needles is designed to encourage drug abuse.
• ―Well, this is just my opinion. The population is growing. People
are dying at slower rates. So they said, ‗let‘s see what happens if
we infect this (HIV) out there‘.‖ (Corbie-Smith 1999)
• ―I think [experimentation on Blacks] is still going on now. Like
AIDS, it was man-made but it kind of got out of hand.‖ (Freimuth
2001)
22
Views Reflect a History
These opinions did not arise from nowhere...
―Slavery, sharecropping, peonage, lynching, Jim Crow laws,
disfranchisement, residential segregation, and job
discrimination formed the substance to which many Black
Americans reduced all American history, forming a saga of
hatred, exploitation, and abuse.‖ (Jones 1991)
23
A Study of ‘Untreated’ Syphilis:
A Failure of Professional Ethics
• ―While the men did not get treated for syphilis, they did get
‗good medical‘ care—care they would not have received
otherwise because of their socioeconomic status.‖ (As perceived
by Nurse Rivers in Hammonds, 1994)
25
Contemporary Experience
―The legacy of the Tuskegee Study endures, in part, because the
racism and disrespect for black lives that it entailed mirror black
people‘s contemporary experiences with medicine.‖ (Blendon et al
1995)
Negative experiences cited by African American and Latino focus
groups (Thom and Campbell 1997)
– lack of respect
– lack of privacy
– deaths of friends or relatives due to what was perceived to be
poor medical care
Minorities report more communication problems with physicians
(Commonwealth Fund, 2002)
African American patients rate their visits with physicians as less
participatory than whites. (Cooper-Patrick et al. 1999)
26
Building Trust is the
Profession’s Responsibility
• Trust confers health benefits
• Minorities mistrust the profession
• There are reasons, both historic and contemporary for
this mistrust, which reflect failures of professional
ethics
• To reduce health disparities and improve outcomes,
the profession must build trust among minority
populations
• How can the profession build trust that has been
breached?
27
Individual Physicians Can...
• Thoroughly Evaluate Problems
• Understand the Patient‘s Individual Experience
• Express Caring
• Provide Appropriate and Effective Treatment
• Communicate Clearly and Completely
• Build a Partnership
• Demonstrate Honesty and Respect for the
Patient
• Address Structural/Staffing Factors
Thom and Campbell 1997
28
Related Online iPapers by Dr. Cray
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THE END, THANK YOU KINDLY
FOR YOUR ATTENTION
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