2. Physician-Based Factors: Maltreatment and Segregated Training
History of Maltreatment and its Effects
The long history of maltreatment of African Americans by the medical system has created a collective memory of exploitation and inferior care that remains an obstacle to effective patient-physician relationships. Qualitative interviews suggest that many African Americans older adults prefer to be kept alive on life supports because of their mistrust of the medical system and fear of suboptimal care (Blackhall, 1999).
Effects of Segregated Training
In addition the history of segregated training for health care providers has left a legacy of under-representation of minority health professionals and contributes to the social distance between African American patients and their healthcare providers. These socioeconomic and class differences partially account for African Americans’ lower satisfaction with health care providers compared to white patients (Malar, 2001).
The legacy of mistrust, exclusion and persistent racial bias (overt or covert) are likely to affect patterns of and responses to communication between healthcare providers, patients and family members” (Welch et al. 2005).