Acceptance of Reassurance as Treatment

To the Editor:

In the April 2000 issue of JFP Schwartz and Wagner¹ concluded, “Patients may be more willing to accept reassurance and over-the-counter medications than is commonly believed by physicians.” This conclusion and the supporting results were very encouraging, especially to those who try to avoid overprescribing. Their data buttressed similar existing findings and personal experience.

Their finding that “African Americans are less likely than whites to accept reassurance as an appropriate treatment” was intriguing and question provoking. Could socioeconomic status and level of education have been confounders? A further issue that was not addressed was the race of the physician doing the reassuring. This is a potential confounder very rarely addressed in studies of this type. Medicine is practiced within a social context. Unfortunately, in our society there is still significant racial distrust, especially of blacks regarding whites. Socioeconomic and education levels could further confound this confounder.

This observational study provided useful information and created questions ripe for further investigation (eg, Do African American patients receive reassurance similarly from all physicians? If yes, then why do they view reassurance differently from their white counterparts? If no, then why?).

Stephen A. Wilson, MD
UPMC St. Margaret
Pittsburgh, Pennsylvania

REFERENCE

1. Schwartz MP, Wagener PJ. Which medicines do our patients want from us? J Fam Pract 2000; 49:339–41.

The preceding letter was referred to Drs Schwartz and Wagner who responded as follows:

Dr Wilson raises important issues in reference to the results of our study addressing African Americans’ versus white persons’ acceptance of reassurance as an appropriate treatment. He is correct in suggesting that socioeconomic status or level of education may have confounded these results. The observed differences in health maintenance organization enrollment rates support these possibilities and were addressed in the discussion. Unfortunately, sample size limitations precluded further examination of these questions. Dr Wilson also raises the question of physician race. Although questions were not specifically asked about the race of the physicians providing the reassurance, these data were collected from the patients who were cared for by one solo-practice white family physician. The issue may be even bigger than is suggested by Dr Wilson in that there may be differences between African Americans and whites in their level of trust of the entire discipline of medicine.

Even more intriguing from a cultural perspective is Dr Wilson’s suggestion that reassuring words and actions may be differently interpreted between these 2 groups. A recent study¹ that examined word descriptors used by African American and white asthma patients suggested that the language used to describe symptoms and lung function are quite different. Surely a variable such as reassurance allows even greater possibility for cultural differences in interpretation and meaning. We commend Dr Wilson for suggesting multiple ways that these preliminary results can be developed so we can more effectively understand, communicate with, and treat persons of differing backgrounds.

Meyer P. Schwartz, MD
Peggy Wagner, PhD
Augusta, Georgia

REFERENCE

1. Hardie GE, Janson S, Gold WM, Carrieri-Kohlman V, Boushey HA. Ethnic differences: word descriptors used by African-American and white asthma patients during induced bronchoconstriction. Chest 2000; 117:938–43.