The effect of patient race upon physician's colorectal cancer screening: A retrospective medical record review and physician pattern variable analysis

There is a significant disparity in the health status of African-Americans and whites in the United States. Studies have revealed that African-Americans have higher mortality rates from colorectal cancer than whites. Differences in colorectal cancer screening of African-Americans compared to whites may account for a proportion of the excess mortality. This study evaluated internal medicine resident physicians' colorectal cancer screening practices in African-American and white patients. Additionally, an analysis of physicians' pattern variable orientation was performed to determine if there was a relationship between physicians' orientation and adherence to colorectal cancer screening guidelines.; A retrospective review of medical records from January 2002 through March 2002 was conducted to assess internal medicine resident physicians' performance of colorectal cancer screening. Univariate analysis revealed that there were statistically significant differences in the rate at which physicians performed rectal examinations (p = 0.0039), fecal occult blood testing (p = 0.0006) and colonic examinations (p < 0.0001) in African-American compared to white patients. Multivariate analysis, evaluating patient race, patient gender, patient age and physician gender, demonstrated that patient race was the only factor significant for not performing colorectal cancer screening tests.; Physicians' perspectives about the medical profession and the delivery of medical services were assessed by evaluating pattern variable orientations. Integrative, value and motivational orientations of the physicians were determined by using semi-structured interviews. All of the physicians had a self-orientation (integrative pattern variable), a universalistic-achievement orientation (value pattern variables) and a specificity orientation (motivational pattern variable). However, the physicians differed in their affectivity-affective neutrality orientation (motivational pattern variable). All of the physicians who had an affective orientation toward their patients adhered to colorectal cancer screening recommendations. The physicians who expressed affective neutrality toward their patients did not adhere to colorectal cancer screening recommendations.; This study revealed significant differences in the performance of colorectal cancer screening in African-American compared to white patients. Additionally, physicians' pattern variable orientations correlated with adherence to practice guidelines. This study is important because it provides information about physician practice patterns. The results of this study can serve as the basis for the development of educational interventions for physicians that can improve health care delivery.