General practice and ethnicity: an experimental study of doctoring

Abstract

Background: There is extensive evidence of health inequality across ethnic groups. Inequity is a complex social phenomenon involving several underlying factors, including ethnic discrimination. In the field of health care, it has been established that ethnic discrimination stems partially from bias or prejudice on the part of doctors. Indeed, it has been hypothesized that patient ethnicity may affect doctors' social cognition, thus modifying their social interactions and decision-making processes. General practitioners (GPs) are the primary access point to health care for ethnic minority groups. In this study, we examine whether patient ethnicity affects the relational and decisional features of doctoring.

Methods: The sample was made up of 171 Belgian GPs, who were each randomly allocated to one of two experimental conditions. One group were given a hypertension vignette case with a Belgian patient (non-minority patient), while the other group were given a hypertension vignette case with a Moroccan patient (minority patient). We evaluated the time devoted by GPs to examining medical history; time devoted by GPs to examining socio-relational history; cardiovascular risk assessments by GPs; electrocardiogram (ECG) recommendations by GPs, and drug prescriptions by GPs.

Results: We observed that for ethnic minority patients, GPs prescribed more drugs and devoted less time to examining socio-relational history. Neither cardiovascular risk assessments nor ECG recommendations were affected by patient ethnicity. GPs who were very busy devoted less time to examining medical history when dealing with minority patients.

Conclusions: We found no evidence that GPs discriminated against ethnic minority patients when it came to medical decisions. However, our study did identify a risk of drugs being used inappropriately in some ethnic-specific encounters. We also observed that, with ethnic minority patients, GPs engage less in the relational dimension of doctoring, particularly when working within a demanding environment. In general practice, the quality of the relationship between doctor and patient is an essential component of the effective management of chronic illness. Our research highlights the complexity of ethnic discrimination in general practice, and the need for further studies.

Figure 1

Interaction between patient’s ethnicity and GPs’ volume of activity in estimation of time devoted by GPs to medical history examination, Belgium, 2012.