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How satisfied you are with your doctor's bedside manner may depend on your racial or ethnic background, according to a recent study. Researchers from the Kaiser Permanente Medical Care Program in northern California and at the University of California, San Francisco, find that differing attitudes about healthcare among Asians, African Americans, Latinos, and whites contribute greatly to how each group rates that care.

The study, based on surveys of 11,494 Kaiser HMO patients aged 35 to 85 who were enrolled in the program at least nine months, shows that Asians are less satisfied with their physician's overall care. Roughly 65 percent rate their doctor "excellent" or "very good," compared to 72 percent of blacks, 72 percent of whites, and 68 percent of Latinos. Just 77 percent of Asians say they would recommend their doctor to a friend or family member, versus 86 percent of blacks, 83 percent of whites, and 83 percent of Latinos. Asians are also less satisfied with their physician's use of technology and communication skills.

Asians' beliefs about the effectiveness of their healthcare account for much of their negative attitudes: 55 percent of Asians in the study - compared to 33 percent of blacks, 38 percent of Latinos, and 17 percent of whites - strongly agree or agree with the statement, "I worry about my health more than other people my age." Asians also have higher expectations of their doctors: 87 percent strongly agree or agree that "recovery from illness requires good medical care more than anything else." Roughly 78 percent of blacks, 78 percent of Latinos, and 60 percent of whites feel the same.

Values matter, as well. While all four groups agree that a doctor's technical skill is "more important than anything else," Latinos, blacks, and Asians place more value on their physicians' display of concern, courtesy, and respect than do whites (see chart).

It's also important to recognize differences among subgroups within a particular race or ethnicity, says Dr. Jann Murray-Garcia, lead author of the report, entitled Racial and Ethnic Differences in a Patient Survey, which was published in the March issue of Medical Care. "We tend to lump racial subgroups together as if they all experience everything the same way," she says. "But by doing so, we are missing some very important differences and experiences." The study, one of the first to separate Asians into subgroups, finds that 64 percent of Chinese, 61 percent of Filipinos, and 67 percent of Japanese give their doctor satisfactory ratings. In comparison, 77 percent of Pacific Islanders are satisfied with their physician and 82 percent would recommend their doctor to a friend.

Until more qualitative studies are done, Murray-Garcia says that it isn't clear whether the study's findings represent actual differences in the quality of care - or variations in patient perceptions, expectations, or questionnaire response styles. Still, she adds, the differences exist and need to be given due attention.

"It's easy to chart and score things quantitatively, but it's a lot harder to make a commitment to look at the sociology of different cultures and spend time asking people poignantly about race and ethnicity," says Murray-Garcia. "We often think that just by asking, we are making an issue out of race. What we don't realize is that the issue is already there."

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