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J Gen Intern Med. 2007 Nov;22(11):1538-43. Epub 2007 Sep 20.

The medical dialogue: disentangling differences between Hispanic and non-Hispanic whites.

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Department of Family Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.



Patients' race and ethnicity play an important role in quality of and access to healthcare in the United States.


To examine the influence of ethnicity--Hispanic whites vs. non-Hispanic whites--on respondents' self-reported interactions with healthcare providers. To understand, among Hispanic whites, how demographic and socioeconomic characteristics impact their interactions with healthcare providers.


Cross-sectional analysis of the 2002 Medical Expenditure Panel Survey, a nationally representative survey on medical care conducted by the Agency for Healthcare Research and Quality.


Civilian, noninstitutionalized U.S. population aged > or = 18 years who reported visiting a healthcare provider within the past 12 months prior to data collection.


After controlling for several demographic and socioeconomic covariates, compared to non-Hispanic whites (reference group), Hispanic whites who had visited a doctor's office or clinic in the past 12 months were more likely to report that their healthcare provider "always" listened to them [odds ratio (OR) = 1.36, 95% confidence interval (CI) 1.21-1.53], explained things so that they understood (OR = 1.25, 95% CI 1.10-1.41), showed respect for what they had to say (OR = 1.52, 95% CI 1.35-1.72), and spent enough time with them (OR = 1.22, 95% CI 1.08-1.38). However, Hispanics were less likely to indicate that their health care provider "always" gave them control over treatment options (OR = 0.83, 95% CI 0.72-0.95) as compared to non-Hispanics. Within the Hispanic population exclusively, age, place of residence, census region, health insurance status, and presence of a usual source of care influenced self-reported interactions with healthcare providers.


Hispanic white respondents were more likely to report that some aspects of provider-patient interactions were indicative of high quality, whereas those related to decision-making autonomy were not. These somewhat paradoxical results should be examined more fully in future research.

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