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Medical Communication with American Indian Older Adults: Implications for Models of Racial/Ethnic Health Disparities |
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Abstract:
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New models of racial/ethnic health disparities suggest that doctors gain less reliable information from minority patients and that resulting “clinical uncertainty” contributes to poorer health outcomes. We examine a possible source of uncertainty by hypothesizing that American Indians structure medical communication differently according to their ethnic characteristics.
We examine audiotapes from 112 primary care visits by older adult members of American Indian tribes who vary in ethnic identity. We use the Roter nteraction Analysis System to classify patient utterances into categories: information-giving, questions, social talk, positive talk, negative talk. We then identify subgroups of patients defined by level of American Indian and White American ethnic identity. Finally, we examine associations between patients’ ethnic identity and patterns of talk.
Patients who strongly identify with American Indian ethnicity devote a significantly greater percentage (p < 0.05) of communication to “positive talk”—including optimism, reassurance, and agreement--than patients who identify weakly. The effect persists after adjustment for health status and sociodemographics. The pattern of talk is consistent with the focus on clinical uncertainty in new models of racial/ethnic health disparities. It potentially encourages providers to underestimate distress and to overestimate satisfaction and comprehension in patients who strongly identity with American Indian ethnicity. |
Most Common Document Word Stems:
patient (139), american (86), ethnic (69), indian (64), provid (54), talk (53), medic (50), communic (49), health (47), care (35), ident (35), posit (32), variabl (32), roter (28), al (27), et (27), question (25), clinic (24), white (24), analysi (23), score (23), |
Author's Keywords:
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health disparities, models, ethnicity, American Indians, uncertainty, communication |
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Association:
Name: American Sociological Association URL: http://www.asanet.org
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Citation:
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MLA Citation:
| Garroutte, Eva., Kunovich, Robert., Buchwald, Dedra. and Goldberg, Jack. "Medical Communication with American Indian Older Adults: Implications for Models of Racial/Ethnic Health Disparities" Paper presented at the annual meeting of the American Sociological Association, Hilton San Francisco & Renaissance Parc 55 Hotel, San Francisco, CA,, Aug 14, 2004 <Not Available>. 2009-05-26 <http://www.allacademic.com/meta/p109896_index.html> |
APA Citation:
| Garroutte, E. M., Kunovich, R. M., Buchwald, D. and Goldberg, J. , 2004-08-14 "Medical Communication with American Indian Older Adults: Implications for Models of Racial/Ethnic Health Disparities" Paper presented at the annual meeting of the American Sociological Association, Hilton San Francisco & Renaissance Parc 55 Hotel, San Francisco, CA, Online <.PDF>. 2009-05-26 from http://www.allacademic.com/meta/p109896_index.html |
Publication Type: Conference Paper/Unpublished Manuscript Review Method: Peer Reviewed Abstract: New models of racial/ethnic health disparities suggest that doctors gain less reliable information from minority patients and that resulting “clinical uncertainty” contributes to poorer health outcomes. We examine a possible source of uncertainty by hypothesizing that American Indians structure medical communication differently according to their ethnic characteristics.
We examine audiotapes from 112 primary care visits by older adult members of American Indian tribes who vary in ethnic identity. We use the Roter nteraction Analysis System to classify patient utterances into categories: information-giving, questions, social talk, positive talk, negative talk. We then identify subgroups of patients defined by level of American Indian and White American ethnic identity. Finally, we examine associations between patients’ ethnic identity and patterns of talk.
Patients who strongly identify with American Indian ethnicity devote a significantly greater percentage (p < 0.05) of communication to “positive talk”—including optimism, reassurance, and agreement--than patients who identify weakly. The effect persists after adjustment for health status and sociodemographics. The pattern of talk is consistent with the focus on clinical uncertainty in new models of racial/ethnic health disparities. It potentially encourages providers to underestimate distress and to overestimate satisfaction and comprehension in patients who strongly identity with American Indian ethnicity. |
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| Document Type: |
.PDF |
| Page count: |
20 |
| Word count: |
6867 |
| Text sample: |
| Medical Communication Patterns among American Indian Older Adults: Implications for Models of Racial/Ethnic Health Disparities and for Patient Care The Institute of Medicine’s 2002 report concludes on the basis of an extensive review of empirical research that racial/ethnic disparities pervade health care. Minorities receive poorer care on a great range of measures. Moreover their health outcomes--from receipt of appropriate diagnostic tests to survival following surgery--are significantly worse than outcomes among White Americans (Smedley Stith & Nelson 2002). Given that |
| H. & Mohr B. (1998). Patient provider communication during the emergency department care of children with asthma. Medical Care 36 1439-50. Woolfson P. Hood V. Secker-Walker R. & Macauley A. C. (1995 December). Mohawk English in the medical interview. Medical Anthropological Quarterly 9(4) 503-9. Won A. Lapane K. Gambassi G. et al. (1999). Correlates and management of nonmalignant pain in the nursing home. SAGE Study Group. Systematic assessment of geriatric drug use via epidemiology. Journal of the American Geriatric |
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