Do minority ethnic groups really have worse experiences of doctor-patient interactions?

For those of us concerned about inequalities – I’m looking at all of you here, obviously – further evidence of their existence is always somewhat of a heartsink. However, when such evidence has the potential to stop people “explaining away” inequalities, I’m going to celebrate it. As some of you well know, patient experience is particularly dear to my heart, having spent the last several years exploring people’s accounts of primary care, and particularly how GPs communicate with their patients.

We ask a lot about patient experience in large-scale national surveys. These health care surveys are also a rich source of evidence of inequalities. Reported variations in care in relation to a patient’s age, gender, sexual orientation, and health status are well known – as are those in relation to ethnicity. South Asian ethnic groups in particular consistently report poorer care in patient surveys. There are two possible explanations for these reports:

1. They get worse care

2. They get the same care, but rate it differently (for example, they vary in their use of response options or have really high expectations of care).

These explanations can be taken to mean:

1. Inequalities in patient care are real – we should do something about it

2. Inequalities in patient care aren’t real – we don’t need to do anything about it

Stimulated by an awareness that many were falling into the latter camp in the face of repeated survey results, we conducted an experimental study to find out which of these explanations was more likely. As a side note – this was the best, most fun study I have ever conducted in my life. Loved every minute: it’d be experimental vignettes all the way for me from now on, if that were possible.

So, the question we wanted to answer was: do South Asian patients rate communication in typical clinical scenarios the same or differently from White British patients? Thanks to our friends at Ipsos MORI, we employed a flotilla of trained fieldworkers to undertake interviews with White British and Pakistani respondents, in the comfort of their own homes (564 White British and 564 Pakistani adults, to be precise – that’s a lot of knocking on doors. True heroes, those fieldworkers). Our participants were asked to rate three video-recordings of simulated GP-patient consultations, using five communication items from the English GP Patient Survey. Once they had all done this, we looked at mean differences in communication score between White British and Pakistani participants.

The results were pretty exciting (well, for me and the statistician Gary anyway: we got quite carried away). Pakistani participants, on average, scored consultations 9.8 points higher (on a 0-100 scale) than White British participants when viewing the same encounters, a statistically significant difference. When adjusted for age, gender, deprivation, self-rated health, and video, the difference increased to 11.0 points.

So, we found substantial differences in ratings between groups, with Pakistani respondents giving higher scores than White British respondents to videos showing the same care. Our findings suggest pretty clearly that the lower scores reported by Pakistani patients in national surveys represent genuinely worse experiences of communication compared to the White British majority. I can’t extrapolate this to other ethnic groups, of course (please feel free to fund me to repeat the study though…). However, for Pakistani populations, we can now be clear that their reports of worse experiences are to be heeded. And, one rather hopes, acted upon.

For the full glorious detail, please head over to BMJ Open for the academic version of this tale:

Burt J, Abel G, Elmore N, Lloyd C, Benson J, Sarson L, Carluccio A, Campbell J, Elliott M, Roland M. Understanding negative feedback from South Asian patients: an experimental vignette study. BMJ Open 2016;6:e011256 doi:10.1136/bmjopen-2016-011256

This entry was posted in Blog and tagged , , , , . Group: . Bookmark the permalink. Both comments and trackbacks are currently closed.
  • The Cambridge Centre for Health Services Research (CCHSR) is a thriving collaboration between the University of Cambridge and RAND Europe. We aim to inform health policy and practice by conducting research and evaluation studies of organisation and delivery of healthcare, including safety, effectiveness, efficiency and patient experience.