R-E-S-P-E-C-T: patient reports of disrespect in the health care setting and its impact on care

Abstract

Objective: The health care encounter is a setting in which racial/ethnic disparities can arise. Patients who experience disrespect in this encounter may be less likely to use health care services that improve outcomes. The objective of this study was to examine factors in the health care encounter and to model how negative perceptions of the encounter influence health care utilization.

Design, subjects, and setting: Data were derived from the Commonwealth Fund 2001 Health Care Quality Survey, a nationwide random-digit-dial survey of 6722 adults, conducted between April 30 and November 5, 2001. Bivariate and multivariate analyses were performed on weighted data.

Main outcome measures: Measures of negative perceptions of the patient-provider relationship included feelings of being treated with disrespect or being looked down upon, a belief that unfair treatment was received due to race or language spoken, and a belief that better treatment would have been received had the respondent had been of a different race. Measures of utilization included receipt of a physical exam within the prior year, receipt of optimal cancer screening and recommended elements of chronic disease care, delay of needed care, and not following the doctor's advice.

Main results: Minorities were significantly more likely to report being treated with disrespect or being looked down upon in the patient-provider relationship. Specifically, 14.1% of blacks (P=.06), 19.4% of Hispanics (P<.001), and 20.2% if Asians (P<.001) perceived being treated with disrespect or being looked down upon, compared with only 9.4% of whites. Persons who thought that they would have received better treatment if they were of a different race were significantly less likely to receive optimal chronic disease screening and more likely to not follow the doctor's advice or put off care (P<.01).

Conclusions: Perceptions of disrespect or of receiving unfair treatment within the patient-provider relationship are prevalent, particularly among racial/ethnic minorities. Such negative perceptions influence health care utilization and may contribute to existing health disparities.