Question

Do ethnic group and gender influence the type of care that a heart patient receives? The following passage is from the article "Heart Care Reflects Race and Sex, Not Symptoms" (USA Today, February 25,1999 , reprinted with permission): Previous research suggested blacks and women were less likely than whites and men to get cardiac catheterization or coronary bypass surgery for chest pain or a heart attack. Scientists blamed differences in illness severity, insurance coverage, patient preference, and health care access. The researchers eliminated those differences by videotaping actorstwo black men, two black women, two white men, and two white women - describing chest pain from identical scripts. They wore identical gowns, used identical gestures, and were taped from the same position. Researchers asked 720 primary care doctors at meetings of the American College of Physicians or the American Academy of Family Physicians to watch a tape and recommend care. The doctors thought the study focused on clinical decision-making. Evaluate this experimental design. Do you think this is a good design or a poor design, and why? If you were designing such a study, what, if anything, would you propose to do differently?

Short answer

The design is good as it tries to isolate the impact of race and gender by controlling other variables. However, it could be improved by including other influential factors like age and more diverse ethnic groups. Finally, the perceived severity needs careful consideration as real patients might express their discomfort differently than actors following a script.

Step-by-step solution

Understanding the Experimental Design

The experiment involves different actors including two black men, two black women, two white men, and two white women. These actors described chest pain from the same script, wore identical gowns, used identical gestures, and were taped from the same position. 720 primary care doctors were then asked to watch a tape and recommend care. The doctors were not made aware of the actual intent of the study. They were led to believe that this study focused on clinical decision-making.

Evaluating the Experimental Design

Now that the experimental design has been understood, it can be evaluated. The design tries to isolate the impact of race and gender on the course of treatment recommended by physicians by keeping other variables constant. This includes the script, gown, gestures, and tape positions. Important variables not directly related to race or gender, have been controlled making it a potentially good design. However, its effectiveness is reliant on the assumption that a real-world scenario can be accurately conveyed using actors and scripts.

Proposing Changes

If there were to be changes made to this design, several proposals could be made. One would be to also incorporate different ages, as age can also be a crucial factor in the decision making of physicians. You could also include more diverse ethnic groups, apart from just black and white individuals, to get a more comprehensive view. Lastly, the perceived severity of the symptoms could vary given that real patients might express their discomfort differently than actors following a script. Therefore, incorporating a wider range of scripts that represent different severity levels could further improve the design.