文章基本信息

标题：Racial/Ethnic Differences in Physician Distrust in the United States
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作者：Katrina Armstrong ; Karima L. Ravenell ; Suzanne McMurphy 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：7
页码：1283-1289
DOI：10.2105/AJPH.2005.080762
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the racial/ethnic and geographic variation in distrust of physicians in the United States. Methods. We obtained data from the Community Tracking Study, analyzing 20 sites where at least 5% of the population was Hispanic and 5% was Black. Results. In univariate analyses, Blacks and Hispanics reported higher levels of physician distrust than did Whites. Multivariate analyses, however, suggested a complex interaction among sociodemographic variables, city of residence, race/ethnicity, and distrust of physician. In general, lower socioeconomic status (defined as lower income, lower education, and no health insurance) was associated with higher levels of distrust, with men generally reporting more distrust than women. But the strength of these effects was modified by race/ethnicity. We present examples of individual cities in which Blacks reported consistently higher mean levels of distrust than did Whites, consistently lower mean levels of distrust than did Whites, or a mixed relationship dependent on socioeconomic status. In the same cities, Hispanics reported either consistently higher mean levels of distrust relative to Whites or a mixed relationship. Conclusions. Racial/ethnic differences in physician distrust are less uniform than previously hypothesized, with substantial geographic and individual variation present. Trust has long been recognized as a fundamental component of the physician–patient relationship. 1 In health care, trust in physicians is generally defined as the belief that the physician will act in your best interest and arises from perceptions of the physician’s values (including fidelity and honesty) and competence. 2 ^– 6 Theoretically, trust is central to a physician–patient relationship because of the risk and uncertainty inherent in medical care. 7 This theoretical framework is supported by studies demonstrating the relationship between physician trust and adherence to treatment recommendations, short-term symptom resolution, and overall health status. 8 ^– 10 It is widely believed that trust has declined over the past 40 years in most segments of US society, including health care. 11 ^, 12 This decline in health care–related trust is attributed to the growth of managed care and for-profit health care, disclosures of prior episodes of unethical medical research, growing public access to medical information, and publicity surrounding medical errors, malpractice, and fraud and abuse within the medical system. 2 ^, 13 Adding to concerns about the overall decline in trust is the recognition that distrust may be particularly prevalent among racial and ethnic minority groups. 14 This recognition has centered on the Black population because of the history of adverse treatment of Blacks by the medical system, dating back to slave experimentation and including the Tuskegee Syphilis Study and current evidence of racial disparities in health care. 15 ^, 16 However, issues such as discrimination that are likely to increase distrust in the Black community may also apply to other disadvantaged minority populations, such as the Hispanic population. Despite the theoretical justification for studying racial differences in health care–related distrust, there are relatively few published empirical studies in this area. Evidence that distrust is higher among minority groups is largely anecdotal and largely focused on the Black population. 17 ^– 19 The few empirical studies that do exist have demonstrated important racial differences in health care but have not examined how other individual characteristics or experiences may modify the association between race and distrust. 14 ^, 20 In addition, most prior studies of health care–related trust or distrust have been limited to a single metropolitan area or have used national data without examining differences across areas. The existence of geographic variation in distrust and racial differences in distrust is potentially important as it suggests that environmental factors may influence distrust. 11 Thus, the purpose of our study was to investigate racial differences in 1 component of physician trust, fidelity-based trust, across metropolitan areas in the United States. Fidelity-based trust corresponds to the belief that the physician will care for “the subject’s interests or welfare” 21 ^(p187) and is analogous to terms such as agency, motives, and fiduciary responsibility that have been used in other definitions of physician trust. 5 ^, 6 ^, 22 We hypothesized that fidelity-based trust of physicians would differ among racial/ethnic groups in the United States and that the size of this difference would vary across communities. Although the relationship of trust and distrust remains controversial in the theoretical literature, for simplicity in this analysis, we used the term physician distrust to describe low scores on items designed to measure fidelity-based trust in physicians.