Video study of physician selection: Preferences in the face of diversity

,

Original Research

Video study of physician selection: Preferences in the face of diversity

J Fam Pract. 2003 July;52(7):552-559

By

Barbara Gerbert, PhD

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References

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ABSTRACT

Objectives: To determine whether a diverse group of people would predominantly choose a white male physician regardless of group member’s sex and ethnicity when given a choice among 6 actor-portrayed video doctors (males and females of Latino, European, and African descent) and whether further exposure would alter initial selections.

Study Design: Participants selected a video doctor after viewing a brief introduction and again after viewing the delivery of a prevention message.

Population: Three hundred ninety-five participants recruited at a shopping mall in the San Francisco Bay Area (61% female, 39% male; 30% Asian American, 29% European American, 26% Latino, 8% African American, and 7% other).

Outcomes Measured: Initial and final video doctor selections; ratings of video doctors on interpersonal qualities.

Results: Most participants (85% of females and 63% of males) initially chose a female video doctor (P<.001) and even more did so at final selection. Approximately half initially chose a same-race video doctor (66% of European Americans, 51% of Latinos, and 50% of African Americans), but fewer did so at final selection (56% of European Americans, 44% of Latinos, and 52% of African Americans). In addition, at final selection 57% of Asian Americans and other-ethnicity participants chose a non–European American video doctor.

Conclusions: Many healthcare consumers will accept physicians of both sexes and of different races. After observing the video doctors demonstrate a professional and warm affect, participants became even more receptive to choosing a video doctor of a different race. Video doctor technology holds promise for increasing our understanding of patients’ preferences.

As the physician workforce diversifies,^1,2 the question of patients’ preferences for physicians by sex and race becomes increasingly important. Early investigations suggested that many patients, especially males, prefer same-sex physicians across a variety of clinical complaints,^3-5 but subsequent studies found these preferences to be more limited,^6-9 except for sex-specific health problems (eg, gynecologic examinations and sexual health issues).¹⁰

A more recent study examining patients’ actual selections of physicians in a large health maintenance organization showed that most patients of both sexes chose a male physician.¹¹ Whether these findings reflect actual patients’ preferences is debatable, however, because patients’ choices may have been influenced by the greater availability of male physicians on the panel.

Compared with sex, even less is known about preferences for physicians’ race, a topic that is complicated by patient and physician attributes such as language, religion, ethnicity, immigration status, acculturation, and multiracial identities. One recent survey on minority health care found that approximately one fourth of African American and Latino patients who had chosen same-race physicians reported explicitly considering the physician’s race or ethnicity in making their selection.¹²

In this study, we examined people’s choices when asked to select a male or female African American, Latino, or European American actor-portrayed “video doctor” to be their physician. Choices were examined at 2 time points: after viewing a brief introduction and after viewing the delivery of a brief health advice message. Our research questions were: After gaining a first impression, will patients choose a male of European descent regardless of their own sex and race? Will exposure to the video doctors’ deliveries of a brief health advice message alter these preferences? The video doctor methodology allowed us to offer participants a verisimilar experience of choosing a physician from a diverse panel and to avoid the limitations of availability and access inherent in real-life choices.

Methods

Video doctor filming and editing

We selected 6 actors of similar age (45 years) and attractiveness: 1 female and 1 male African American, Latino, and European American. We used the term Latino to represent a racial identity characterized by dark hair and a medium complexion. The fictitious surnames of the Latino and Latina video doctors also indicated their ethnicity.

When producing the video doctor presentations, we held constant the script, the setting (a doctor’s office), and the clothing. Two segments were produced for each video doctor: a brief introduction in which the doctor used a fictitious name assigned by the researchers to say, for example, “Hi, I’m Dr. Ann Johnson,” and a 45-second health advice message about eating 5 fruits and/or vegetables a day (chosen because of the neutral and universally relevant nature of this topic). The health message contained key elements known to enhance effectiveness of brief interventions.¹³ The actors’ deliveries of the message were standardized to include interpersonal elements associated with patient-centered health care and positive patient behavior change—for example, warmth, friendliness, empathy, and a nonjudgmental, respectful, and collaborative affect.^14,15 (A full description of our procedures is available in Appendix A at www.jfponline.com.)