Impact of Physician Race on Patient Decision-Making and Ratings of Physicians: a Randomized Experiment Using Video Vignettes

Abstract

Background: Studies suggest that black patients have better interactions, on average, with physicians of their own race. Whether this reflects greater “cultural competence” in race-concordant relationships, or other effects of race unrelated to physician behavior, is unclear. It is also unclear if physician race influences patient decision-making. Objective: To determine whether physician race affects patients’ ratings of physicians and decision-making, independent of physician behavior. Design: Randomized study using standardized video vignettes. Participants: Primary care patients with coronary risk factors or disease. Interventions: Each participant viewed one of 16 vignettes depicting a physician reviewing cardiac catheterization results and recommending coronary artery bypass graft (CABG) surgery. Vignettes varied only in terms of physicians’ race, gender, age, and communication style (high vs. low patient-centeredness). Main Measures: Participants rated the video physician’s communication, interpersonal style, competence, trustworthiness, likability, and overall performance (0–4 Likert scales). They also rated the necessity of CABG (0–5 scale) and whether they would undergo CABG or obtain a second opinion if they were the video patient (0–3 scales). Key Results: Participants included 107 black and 131 white patients (72% participation rate). Black participants viewing a black (vs. white) video physician gave higher ratings on all physician attributes (e.g., overall rating 3.22 vs. 2.34, p < 0.001) and were more likely to perceive CABG as necessary (4.05 vs. 3.72, p = 0.03) and say they would undergo CABG if they were the video patient (2.43 vs. 2.09, p = 0.004). Patient-centered communication style reduced, but did not eliminate, the impact of race concordance. Physician race was not associated with any outcomes among white patients. Conclusions: Black patients viewed the doctor in a scripted vignette more positively, and were more receptive to the same recommendation, communicated in the same way, with a black vs. white physician. Patient-centered communication reduced but did not eliminate the effect of physician race.