The authors analyzed audiotapes from 102 patients of American Indian race (≥50 years) to explore how ethnic identity influences medical communication. A standardized interaction analysis system was used to classify patient utterances into categories: information-giving, questions, social talk, positive talk, negative talk. The authors identified patient subgroups distinguished by level of identification with American Indian and White identity and explored whether some subgroups devoted more communication to certain categories of talk. Patients highly affiliated with American Indian identity devoted a significantly greater percentage of communication to “positive talk”—including statements of optimism, reassurance, and agreement—than patients identifying at lower levels (p > .05). They devoted less communication to “negative talk,” including corrections, disagreements, and anxiety statements (p < .05). Effects persisted after adjustment for confounders, including health status. Patterns may encourage providers to underestimate distress and overestimate satisfaction and comprehension in patients highly affiliated with American Indian identity.
Anderson, K. O., Richman, S. P., Hurley, J., Palos, J., Valer, V., Mendoza, T. R., et al. (2002). Cancer pain management among underserved minority out patients: Perceived needs and barriers to optimal control. Cancer, 94, 2295-2304.
2.
Ashton, C. M., Haidet, P., Paterniti, D. A., Collins, T. C., Gordon, H. S., O’Malley, K., et al. (2003). Racial and ethic disparities in the use of health services. Journal of General Internal Medicine, 18, 146-152.
3.
Balsa, A. I., & McGuire, T. G. (2003). Statistical discrimination in health care. Journal of Health Economics, 20, 881-907.
4.
Bartlett, E. E., Grayson, M., Barker, R., Levine, D. M., Golden, A., & Libber, S. (1984). The effects of physician communications skills on patient satisfaction, recall, and adherence. Journal of Chronic Disease, 37, 755-764.
5.
Bartz, R. (1999). Beyond the biopsychosocial model: New approaches to doctor-patient interactions. Journal of Family Practice, 48, 601-607.
6.
Bensing, J. M., Roter, D. L., & Hulsman, R. L. (2003). Communication patterns of primary care physicians in the United States and Netherlands. Journal of General Internal Medicine, 18, 335-342.
7.
Bonham, V. L. (2001). Race, ethnicity, and pain treatment: Striving to understand the causes and solutions to the disparities in pain treatment. Journal of Law, Medicine, and Ethics, 29, 52-68.
8.
Buchwald, D., Beals, J., & Manson, S. M. (2000). Use of traditional health practices among Native Americans in a primary care setting. Medical Care, 38(12), 1191-1199.
9.
Carrese, J. A., & Rhodes, L. A. (2000). Bridging cultural differences in medical practice: The case of discussing negative information with Navajo patients. Journal of General Internal Medicine, 15, 92-96.
10.
Chun, C.-A., Enomoto, K., & Sue, S. (1996). Health care issues among Asian Americans: Implications of somatization. In P. M. Kato & T. Mann (Eds.), Handbook of diversity issues in health psychology (pp. 347-366). New York: Plenum.
11.
Fagerhaugh, S. Y., & Straus, A. (1977). A politics of pain management: Staff-patient interaction. Menlo Park, CA: Addison-Wesley.
12.
Garroutte, E. M. (2003). Real Indians: Identity and the survival of Native America. Berkeley: University of California Press.
13.
Garroutte, E. M., Kunovich, R. M., Jacobsen, C., & Goldberg, J. (2004). Patient satisfaction and ethnic identity among American Indian older adults. Social Science & Medicine, 59(11), 2233-2244.
14.
Green, C. R., Anderson, K. O., Baker, T. A., Campbell, L. C., Decker, S., Fillingim, R. B., et al. (2003). The unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain Medicine, 4(3), 277-294.
15.
Hall, J. A. (1984). Nonverbal sex differences: Communication accuracy and expressive style. Baltimore, MD: Johns Hopkins University Press.
16.
Hall, J. A., Roter, D. L., & Katz, N. R. (1988). Meta-analysis of correlates of provider behavior in medical encounters. Medical Care, 26(7), 657-675.
17.
Haug, M. R. (1996). Elements in physician/patient interactions in late life. Research on Aging, 18(1), 32-51.
18.
Heurtin-Roberts, S., Snowden, L., & Miller, L. (1997). Expressions of anxiety in African Americans: Ethnography and the Epidemiological Catchment Area Studies. Culture, Medicine, and Psychiatry, 21, 337-363.
19.
Huttlinger, K., Krefting, L., Drevdahl, D., Tree, P., Baca, E., & Benally, A. (1992). “Doing battle”: A metaphorical analysis of diabetes mellitus among Navajo people. American Journal of Occupational Therapy, 46, 706-712.
20.
Inui, T. S., Carter, W. B., Kukull, W. A., & Haigh, V. H. (1982). Outcome-based doctor-patient interaction analysis: I. Comparison of techniques. Medical Care, 20(6), 535-549.
21.
Kaplan, S. H., Gandek, B., Greenfield, S., Rogers, W., & Ware, J. E. (1995). Patient and visit characteristics related to physicians’ participatory decision-making style: Results from the Medical Outcomes Study. Medical Care, 33(12), 176-187.
22.
Kilpatrick, J. F., & Kilpatrick, A. G. (1965). Walk in your soul: Love incantations of the Oklahoma Cherokees. Dallas, TX: Southern Methodist University Press.
23.
Kilpatrick, J. F., & Kilpatrick, A. G. (1967). Run toward the Nightland: Magic of the Oklahoma Cherokee. Dallas, TX: Southern Methodist University Press.
24.
Kramer, B. J., Harker, J. O., & Wong, A. L. (2002a). Arthritis beliefs and self-care in an urban American Indian population. Arthritis and Rheumatism, 47(6), 588-594.
25.
Kramer, B. J., Harker, J. O., & Wong, A. L. (2002b). Descriptions of joint pain by American Indians: Comparisons of inflammatory and noninflammatory arthritis. Arthritis and Rheumatism, 47(2), 149-154.
26.
Lang, G. C. (1989). “Making sense” about diabetes: Dakota narratives of illness. Medical Anthropology, 22, 305-327.
27.
Lawlis, G. G., Achterberg, J., Kenner, L., & Kopetz, K. (1984). Ethnic and sex differences in response to clinical and induced pain in chronic spinal pain patients. Spine, 9(7), 751-754.
28.
Lipton, J. A., & Marbach, J. J. (1984). Ethnicity and the pain experience. Social Science & Medicine, 19(12), 1279-1298.
29.
Loftin, J. D. (1983). The “harmony ethic” of the conservative Eastern Cherokee: A religious interpretation. Journal of Cherokee Studies, 8(1), 40-43.
30.
Maly, R. C., Leake, B., Frank, J. C., DiMatteo, M. R., & Reuben, D. B. (2002). Implementation of consultative geriatric recommendations: The role of patient-primary care physician concordance. Journal of the American Geriatric Society, 50(8), 1372-1380.
31.
Meredith, L. S., & Siu, A. L. (1995). Variation and quality of self-report health data. Asians and Pacific Islanders compared with other ethnic groups. Medical Care, 33(11), 1120-1131.
32.
Moran, J. R., Fleming, C. M., Somervell, P., & Manson, S. M. (1999). Measuring ethnic identity among American Indian adolescents. Journal of Adolescent Research, 14(4), 405-426.
33.
Novins, D. K., Beals, J., Moore, L. A., Spicer, P., Manson, S. M., & the AI-SUPERPFP Team. (2004). Use of biomedical services and traditional healing options among American Indians: Sociodemographic correlates, spirituality, and ethnic identity. Medical Care, 42(7), 670-679.
34.
Oetting, E. R., & Beauvais, F. (1990-1991). Orthogonal cultural identification theory: The cultural identification of minority adolescents. International Journal of Addictions, 25(5A-6A), 655-685.
35.
Ong, L. M. L., de Haes, J. C., Hoos, A. M., & Lammes, F. B. (1995). Doctor-patient communication: A review of the literature. Social Science & Medicine, 40(7), 903-918.
36.
Raudenbush, S. W. (2000). HLM 5: Hierarchical linear and nonlinear modeling (2nd ed.). Lincolnwood, IL: Scientific Software International.
37.
Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods. Thousand Oaks, CA: Sage.
38.
Roter, D., & Larson, S. (2002). The Roter Interaction Analysis System (RIAS): Utility and flexibility for analysis of medical interactions. Patient Education and Counseling, 46(4), 243-251.
39.
Roter, D., Rosenbaum, J., de Negri, B., Renaud, D., DiPrete-Brown, L., & Hernandez, O. (1998). The effects of a continuing medical education programme in interpersonal communication skills on doctor practice and patient satisfaction in Trinidad and Tobago. Medical Education, 32(2), 181-189.
40.
Roter, D. L. (2000). The outpatient medical encounter and elderly patients. Clinics in Geriatric Medicine, 16(1), 95-107.
41.
Roter, D. L. (2001). Roter Interaction Analysis System: Coding manual. Baltimore: Johns Hopkins University. Retrieved June 29, 2005, from www.rias.org (Available from the author at droter@jhsph.edu)
42.
Roter, D. L., & Hall, J. A. (1993). Doctors talking with patients/patients talking with doctors. Westport, CT: Auburn House.
43.
Roter, D. L., Hall, J. A., & Katz, N. R. (1988). Patient-physician communication: A descriptive summary of the literature. Patient Education and Counseling, 12(2), 99-119.
44.
Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.
45.
Steeler, C. W. (2001). Improving American Indian health care: The Western Cherokee experience. Norman: University of Oklahoma Press.
46.
Stewart, M., Brown, J. B., Boon, H., Galajda, J., Meredith, L., & Sangster, M. (1999). Evidence on patient-doctor communication. Cancer Prevention and Control, 3(1), 25-30.
47.
Templin, D. W., Boyer, G. S., Lanier, A. P., Nelson, J. L., Barrington, R. A., Hansen, J. A., et al. (1994). Rheumatoid arthritis in Tlingit Indians: Clinical characterization and HLA associations. Journal of Rheumatology, 21(7), 1238-1244.
48.
Thomas, R. K. (1958). Cherokee values and world-view (NCC CP970.03 T461c p. 6). Unpublished manuscript, University of North Carolina at Chapel Hill.
49.
Todd, K. H., Samaroo, N., & Hoffman, J. R. (1993). Ethnicity as a risk factor for inadequate emergency department analgesia. Journal of the American Medical Association, 269(12), 1537-1539.
50.
U.S. Census Bureau. (2001). Statistical abstract of the United States. Section 1: Population. Retrieved May 21, 2004, from http://www.census.gov/prod2002pubs/01statab/stat-ab01.html
51.
van Ryn, M. (2002). Research on the provider contribution to race/ethnicity disparities in medical care. Medical Care, 40(Suppl. 1), I140-I151.
52.
Ware, J. E. (2001). How to score and interpret single-item health status measures: A manual for users of the SF-8 Health Survey. Lincoln, RI: Quality Metric.
53.
Wartman, S. A., Morlock, L. L., Malitz, F. E., & Palm, E. (1983). Impact of divergent evaluations by physician and patients of patients’ complaints. Public Health Reports, 98(2), 141-145.
54.
Weinstein, M. C. (1980). Clinical decision analysis. Philadelphia: W. B. Saunders.
55.
Woolfson, P., Hood, V., Secker-Walker, R., & Macauley, A. C. (1995). Mohawk English in the medical interview. Medical Anthropological Quarterly, 9(4), 503-509.
56.
Wolraich, M. L., Albanese, M., Stone, G., Nesbitt, D., Thomson, E., Shymansky, J., et al. (1986). Medical communication behavior system. An interactional analysis system for medical interactions. Medical Care, 24(10), 891-903.
57.
Zborowski, M. (1966). People in pain. San Francisco: Jossey-Bass.
58.
Zola, I. K. (1966). Culture and symptoms—an analysis of patients’ presenting complaints. American Sociological Review, 31(5), 615-630.
