Delving Below the Surface

Understanding How Race and Ethnicity Influence Relationships in Health Care

Authors

  • Lisa A. Cooper MD, MPH,

    1. Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins University, Baltimore, MD, USA
    2. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
    3. Department of Health Policy & Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
    4. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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  • Mary Catherine Beach MD, MPH,

    1. Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins University, Baltimore, MD, USA
    2. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
    3. Department of Health Policy & Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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  • Rachel L. Johnson MD, PhD,

    1. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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  • Thomas S. Inui MD, ScM

    1. Regenstrief Institute, Indiana University Medical Center, Indianapolis, IN, USA.
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  • The authors have no conflicts of interest to report. This work was presented in part at the Ninth Regenstrief Conference, “Re-Forming Relationships in Healthcare, September 29 to October 1, 2004, Turkey Run State Park, Indiana.

Address correspondence and requests for reprints to Dr. Cooper: Welch Center for Prevention, Epidemiology, & Clinical Research, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21205-2223 (e-mail: lisa.cooper@jhmi.edu).

Abstract

There is increasing evidence that racial and ethnic minority patients receive lower quality interpersonal care than white patients. Therapeutic relationships constitute the interpersonal milieu in which patients are diagnosed, given treatment recommendations, and referred for tests, procedures, or care by consultants in the health care system. This paper provides a review and perspective on the literature that explores the role of relationships and social interactions across racial and ethnic differences in health care. First, we examine the social and historical context for examining differences in interpersonal treatment in health care along racial and ethnic lines. Second, we discuss selected studies that examine how race and ethnicity influence clinician-patient relationships. While less is known about how race and ethnicity influence clinician-community, clinician-clinician, and clinician-self relationships, we briefly examine the potential roles of these relationships in overcoming disparities in health care. Finally, we suggest directions for future research on racial and ethnic health care disparities that uses a relationship-centered paradigm.

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