Disparities/Minority Health

Older American Indians often have a poorer view of their own health than their doctors

Older American Indians, whose health is generally worse than non-Indians in the United States, often view their health as worse than their doctors do. This is particularly true if they only weakly identify with the white-American culture of their doctors, according to a new study. Investigators surveyed 115 patients 50 years and older who sought care at a Cherokee Nation clinic, and their 7 health care providers. Both providers and patients completed American-Indian identity and white-American identity indexes. All but one provider identified strongly as a white American.

In 40 percent of medical visits, providers and patients rated the patient's health differently. In 68 percent of these cases, providers rated patients healthier than the patients rated themselves. Provider-patient differences were larger for the Cherokee patients who identified weakly with white culture than those who felt stronger affiliation. This finding is consistent with research suggesting that providers may overlook illness among patients who are racially or culturally different.

Discordant perceptions between providers and patients about the patient's health are associated with inadequate and unnecessary treatment, poor adherence to treatment advice, dissatisfaction with care, diminished symptom resolution, and mismatching of care services to needs. Discordant perceptions of health status pose special concerns for chronically ill patients, who must carefully follow providers' advice to maintain their health, and for older patients, who are often unassertive with providers and unlikely to challenge their perceptions. The researchers note that future studies should investigate the reasons for the differences in perceived health status between culturally diverse patients and their providers. The study was supported in part by the Agency for Healthcare Research and Quality (HS10854).

See "Cultural identities and perceptions of health among health care providers and older American Indians," by Eva Marie Garroutte, Ph.D., Natalia Sarkisian, Ph.D., Lester Arguelles, Ph.D., and others, in the February 2006 Journal of General Internal Medicine 21, pp. 111-116.

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