The Doctor Never Listens: Older Black Men, Patient-Provider Communication and the Role of Social Workers in Helping Them Feel Heard

Background: Compared to non-Hispanic White men in the U.S., African American men are more likely to be diagnosed with a variety of chronic conditions and have higher rates of mortality and morbidity. Effective patient-provider communication can play a critical role in both the delivery of meaningful care and positive health outcomes in minority communities. African Americans report less satisfaction with patient-provider communication and less shared decision-making when compared to Whites. These findings are particularly relevant for African American men who experience higher morbidity, poorer prognoses, and higher mortality across a range of chronic diseases, however, little is known about factors that influence patient-provider communication among African American men.  The objective of this study was to identify sociodemographic and other factors that influence patient-provider communication among African American men.

Methods: This study uses baseline data of 1666 men from a longitudinal patient navigation intervention of older African American adults enrolled in Medicare. Bivariate and logistic regression analysis were used to analyze the data.

Results: Participants older than 75 (OR= 1.476; p<0.05). Men who were married or partnered (OR=1.918; p<0.001), those reported feeling downhearted or blue most of the time (OR=1.930; p<0.001) and men who had a big problem with getting health care (OR=12.146;P<0.001) experienced more communication problems. Reporting trouble with mobility was also moderately significant (OR=1.318; p<0.1).

Conclusion and Implications: In the current study, men who may already be at risk of being medically underserved, those age 75 or older, men with depressive symptoms, and those facing significant difficulty accessing the health care system were the same participants who reported that their doctor never listened to them.  More research is needed to examine what factors influence patient-provider communication in African American men. Further, social workers can play a key role in facilitating higher quality patient-provider communication. Social workers are particularly well trained to identify and assess the needs of older African American men experiencing emotional issues, mobility problems and problems with obtaining health care, who may be at higher risk for having suboptimal medical interactions with physicians. Owing to the finding that difficulty accessing health care increases the perception of poor patient-provider communication among older African American men in this study, social work clinicians are critical gatekeepers who may be able to assess a patient’s understanding of and ability to navigate the health care system, connect them with resources, and also work as a cultural broker to aid physicians and other health providers in understanding how age, culture, gender, and possible prior poor healthcare experiences may shape how individual patients respond to medical advice, express concerns, or involve family members in decision-making.