nonaccusatory and collaborative
nonaccusatory and collaborative
A limitation of this study is that our sample may not be representative of all psychiatrists practicing in the United States, because members of the APA and psychiatrists who attend APA meetings may be systematically different from other psychiatrists. Our response rate was adequate for this type of study, but response bias may limit the generalizability of our results—that is, we cannot determine whether psychiatrists who elected to participate in the study are systematically different from those who did not respond. Moreover, all data were collected by self-report, which may make comparisons less reliable. We attempted to standardize responses by defining all key terms, but our findings must be interpreted as stemming from respondents’ subjective beliefs. Finally, the cross-sectional study design prevents us from drawing conclusions as to causation. Longitudinal research is needed to clarify the direction of the relationships that we have reported.
Conclusions
Once physicians have begun to consider their own role in perpetuating racial-ethnic disparities and have expressed an interest in changing their behaviors, what are the most effective interventions? Increasing awareness of racial-ethnic disparities is useful but insufficient ( 17 ). When educational interventions are undertaken, they may be most effective when presented from within the provider community—for example, educational information presented by the APA or other national or local professional groups may be deemed more authoritative and believable than information from other sources ( 16 ).
Ideally, programs to reduce disparities should include a component to demonstrate the existence of disparities within the physicians’ own practices ( 17 ). For example, hospitals or CMHCs may collect data on patient outcomes or patient satisfaction and examine these findings for correlations with race-ethnicity. Reporting these findings to the treating physicians may help physicians to understand and accept the pervasive nature of racial-ethnic disparities ( 13 ). In the authors’ personal experience, however, a major limitation of this approach is that such feedback may be met with skepticism by physicians who are not yet prepared to confront their own role in the existence of disparities. Broaching this topic with physicians in a nonaccusatory and collaborative manner is essential for success.
In addition to providing information, programs to reduce disparities in clinical care should also emphasize cultural sensitivity and cultural competence. Cultural sensitivity refers to one’s insight into his or her own cultural beliefs and experiences (13 ), whereas cultural competence refers to one’s ability to understand and respond effectively to others’ cultural needs and to establish interpersonal relationships bridging cultural differences ( 7 ). Several components of effective cultural sensitivity and cultural competence training programs have been described. First, programs should help clinicians understand how their own experiences affect their perceptions of other races ( 13 , 18 ). Second, programs should help clinicians become aware of the circumstances that activate racial-ethnic stereotyping ( 13 ). Third, programs should introduce communication techniques that help clinicians approach their patients as individuals; the “patient-centered communication” approach is perhaps the most widely described and advocated of these techniques ( 7 , 9 , 13 , 19 ). Finally, programs should help clinicians learn to attend selectively to relevant racial-ethnic and cultural information and screen out irrelevant information ( 20 ). Relevant information may include cultural differences in health beliefs, medical practices, attitudes toward medical care and the medical system, and levels of trust of physicians ( 3 ). Relevant information may also include differences in incidence and prevalence of certain illnesses among specific groups and differences in pharmacokinetics and pharmacodynamics (ethnopharmacology) ( 3 , 21 ).
