anxiety (van Ryn, 2002). In the typical health care encounter, some of these conditions are present, particularly cognitive complexity and time pressure.

The possibility that some health care providers may hold particular stereotypes is suggested by a few studies in which physicians were found to view their black patients more negatively than white patients (Finucane and Carrese, 1990; van Ryn and Burke, 2000). For instance, van Ryn and Burke (2000) found that—.even after adjusting for patient age, sex, socioeconomic status, sickness or frailty and overall health, and patient availability of social support—physicians viewed black patients, compared with whites, as less kind, congenial, intelligent, and educated, less likely to adhere to medical advice, and more likely to lack social support and to abuse alcohol and drugs. Experimental studies of physicians (Schulman et al., 1999; Weisse et al., 2001) and medical students (Rathore et al., 2000) provide evidence that the experimental manipulation of hypothetical patients’ characteristics such as race can lead to variations in provider perceptions.

But do stereotypes actually affect patient care? There is little evidence on this issue, though one may hypothesize various possibilities. For instance, a health care provider may interpret symptoms in line with beliefs about group differences. These beliefs might be based on generalizations from clinical experience (Satel, 2000, 2001-2002), or a provider may also select treatments based on stereotypical assumptions about patient behavior. Some research tackles this latter possibility. A national sample of AIDS care physicians predicted that, among hypothetical patients, black men would be less likely to adhere to antiretroviral therapy—a generalization that may be right for some therapies but not others (see below). Since potential adherence to therapy is a factor in decisions to start treatment, the inference might be drawn that black men would be less likely to receive such care, but this potential effect of stereotypes was not actually demonstrated (Bogart et al., 2001). Somewhat similarly, van Ryn et al. (1999; cited in van Ryn and Fu, 2003) found that physicians rated black patients, in comparison with white patients, as more likely to be lacking in social support and less likely to participate in cardiac rehabilitation. The likelihood of such participation is a factor in recommending revascularization, but the researchers did not link any difference in recommendations to the stereotype.

Whether medical decisions are actually affected by stereotypes is therefore not known. It would be useful to determine how often stereotypes are activated, in what circumstances, and what medical decisions are indeed affected. In principle, stereotypes would not be a problem if treatment decisions were entirely individualized (as suggested earlier, in the genetics section, as a long-term goal). However, negative stereotypes could still make the provider-patient interaction uncomfortable, which could hamper such individualization by restricting the full exchange of information. Such processes may well be important in particular individual cases but their



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