Racial and Ethnic Disparities in the Use of Health Services

Bias, Preferences, or Poor Communication?

Authors

  • Carol M. Ashton MD, MPH,

    Corresponding author
    1. Received from Baylor College of Medicine (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), and the Houston Veterans' Affairs Medical Center (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), Houston, Tex; and Texas A&M University (BFS, RLS), College Station, Tex.
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  • Paul Haidet MD, MPH,

    1. Received from Baylor College of Medicine (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), and the Houston Veterans' Affairs Medical Center (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), Houston, Tex; and Texas A&M University (BFS, RLS), College Station, Tex.
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  • Debora A. Paterniti PhD,

    1. Received from Baylor College of Medicine (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), and the Houston Veterans' Affairs Medical Center (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), Houston, Tex; and Texas A&M University (BFS, RLS), College Station, Tex.
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  • Tracie C. Collins MD, MPH,

    1. Received from Baylor College of Medicine (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), and the Houston Veterans' Affairs Medical Center (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), Houston, Tex; and Texas A&M University (BFS, RLS), College Station, Tex.
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  • Howard S. Gordon MD,

    1. Received from Baylor College of Medicine (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), and the Houston Veterans' Affairs Medical Center (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), Houston, Tex; and Texas A&M University (BFS, RLS), College Station, Tex.
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  • Kimberly O'Malley PhD,

    1. Received from Baylor College of Medicine (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), and the Houston Veterans' Affairs Medical Center (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), Houston, Tex; and Texas A&M University (BFS, RLS), College Station, Tex.
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  • Laura A. Petersen MD, MPH,

    1. Received from Baylor College of Medicine (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), and the Houston Veterans' Affairs Medical Center (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), Houston, Tex; and Texas A&M University (BFS, RLS), College Station, Tex.
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  • Barbara F. Sharf PhD,

    1. Received from Baylor College of Medicine (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), and the Houston Veterans' Affairs Medical Center (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), Houston, Tex; and Texas A&M University (BFS, RLS), College Station, Tex.
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  • Maria E. Suarez-Almazor MD, PhD,

    1. Received from Baylor College of Medicine (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), and the Houston Veterans' Affairs Medical Center (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), Houston, Tex; and Texas A&M University (BFS, RLS), College Station, Tex.
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  • Nelda P. Wray MD, MPH,

    1. Received from Baylor College of Medicine (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), and the Houston Veterans' Affairs Medical Center (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), Houston, Tex; and Texas A&M University (BFS, RLS), College Station, Tex.
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  • Richard L. Street Jr. PhD

    1. Received from Baylor College of Medicine (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), and the Houston Veterans' Affairs Medical Center (CMA, PH, DAP, TCC, HSG, KO, LAP, MES-A, NPW), Houston, Tex; and Texas A&M University (BFS, RLS), College Station, Tex.
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Address correspondence and requests for reprints to Dr. Ashton: VA Medical Center (152), 2002 Holcombe, Houston, TX 77030 (e-mail: cashton@bcm.tmc.edu).

Abstract

African Americans and Latinos use services that require a doctor's order at lower rates than do whites. Racial bias and patient preferences contribute to disparities, but their effects appear small. Communication during the medical interaction plays a central role in decision making about subsequent interventions and health behaviors. Research has shown that doctors have poorer communication with minority patients than with others, but problems in doctor-patient communication have received little attention as a potential cause, a remediable one, of health disparities. We evaluate the evidence that poor communication is a cause of disparities and propose some remedies drawn from the communication sciences.

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