Understanding why some ethnic minority patients evaluate medical care more negatively than white patients: a cross sectional analysis of a routine patient survey in English general practices
Mead and Roland report differences in patient experience that are
related to patient ethnicity. It seems there is a possible confounder,
physician characteristics, which was not corrected for. (1)
We examined the relationship between patient ethnicity and the
percentage of UK graduate doctors at practice level, using the 2004 GP
Research Database data on country of primary qualification and the patient
declared ethnicity in the 2006/07 GP Patient Survey. We summed the Asian
and mixed Asian subgroups and the Black and mixed Black subgroups in the
survey to reflect the groups reported in the study. UK graduate and
ethnicity data could be matched for 8047 of 8386 (96%) English practices
in the 2006/07 GP Patient Survey. (2) (3)
There is a positive relationship between patient declared white
British status and percentage of UK graduates in the practice (r=0.35,
p<0.001). Similarly there is a negative relationship between proportion
UK graduate physicians in the practice and proportion of Asian or Black
ethnic group patients (r=-0.35 and r=-0.23 respectively, p<0.001).
It seems therefore that Asian and Black ethnic patients are being
cared for by practices with a higher proportion of foreign medical
graduates, and it is likely they are experiencing a different primary care
service in England.
Rapid Response:
Physician factors
Dear editor,
Mead and Roland report differences in patient experience that are
related to patient ethnicity. It seems there is a possible confounder,
physician characteristics, which was not corrected for. (1)
We examined the relationship between patient ethnicity and the
percentage of UK graduate doctors at practice level, using the 2004 GP
Research Database data on country of primary qualification and the patient
declared ethnicity in the 2006/07 GP Patient Survey. We summed the Asian
and mixed Asian subgroups and the Black and mixed Black subgroups in the
survey to reflect the groups reported in the study. UK graduate and
ethnicity data could be matched for 8047 of 8386 (96%) English practices
in the 2006/07 GP Patient Survey. (2) (3)
There is a positive relationship between patient declared white
British status and percentage of UK graduates in the practice (r=0.35,
p<0.001). Similarly there is a negative relationship between proportion
UK graduate physicians in the practice and proportion of Asian or Black
ethnic group patients (r=-0.35 and r=-0.23 respectively, p<0.001).
It seems therefore that Asian and Black ethnic patients are being
cared for by practices with a higher proportion of foreign medical
graduates, and it is likely they are experiencing a different primary care
service in England.
(1) Mead N and Roland M. Understanding why some ethnic minority
patients evaluate medical care more negatively than white patients. BMJ
2009;339:b3450. http://www.bmj.com/cgi/content/full/339/sep16_3/b3450
(2) The General Practice Research Database. Data related to 2004,
downloaded in April 2007. http://www.gprd.com/home/
(3) Department of Health. GP patient surveys. London 2009.
http://www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/GPpati...
Competing interests:
None declared
Competing interests: No competing interests