Physician cultural competence and patient ratings of the patient-physician relationship

OBJECTIVE: To determine the association of patients' ratings of the patient-physician relationship with physicians' self-reported cultural competence (CC). METHODS: Physicians completed a survey assessing their CC in three domains: motivation to learn about other cultures (motivation attitudes), awareness of white privilege and acceptance of a racial group's choice to retain distinct customs and values (power assimilation attitudes), and clinical behaviors reflective of CC. Their African-American and white patients completed interviews assessing satisfaction with the medical visit, trust in their physician, perceptions of their physician's respect for them and their participation in care. We conducted regression analyses to explore the associations between CC and patient ratings of the relationship. RESULTS: Patients of physicians reporting more motivation to learn about other cultures were more satisfied (OR=2.1, 95% CI=1.0-4.4), perceived their physicians were more facilitative (β=0.4, p=0.02) and reported seeking and sharing more information during the medical visit (β=0.2, p=0.03). Physicians' power assimilation attitudes were associated with patients' ratings of physician facilitation (β=0.4, p=0.02). Patients of physicians reporting more frequent CC behaviors were more satisfied (OR=3.1, 95% CI=1.4-6.9) and reported seeking and sharing more information (β=0.3, p=0.04). CONCLUSIONS: Attitudinal and behavioral components of CC are important to developing higher quality, participative relationships between patients and their physicians.