The IOM report attempted to identify likely causal factors, highlighting the role of clinician-patient interaction as a contributing factor to service disparities. The Agency for Healthcare Research and Quality's National Healthcare Disparities Report 2 reinforced the IOM's findings, crystallizing public concern about racial and ethnic disparities in healthcare in the United States. In 2002, The Institute of Medicine 1 (IOM) reported results from its congressionally mandated study of existing evidence of racial and ethnic disparities in healthcare. Differential discussion of symptom areas, depending on patient ethnicity, may lead to differential diagnosis and increased likelihood of diagnostic bias. We found Latino ethnicity to be a modifying factor of the association between symptom reports and likelihood of a depression diagnosis. With limited diagnostic information, clinicians can optimize the clinical intake time to establish rapport with patients. Most clinicians rely on patients' mention of depression, anxiety, or substance use to identify disorders, without assessing specific criteria. We found high levels of concordance between clinicians for substance-related disorders, low levels for depressive disorders, and anxiety disorders except panic. Videos were coded by another clinician using an information checklist, blind to the diagnoses provided by the original clinician. A total of 129 mental health intakes were videotaped, involving 47 mental health clinicians from 8 primarily safety-net clinics. We describe a study examining contributions to clinician bias during diagnostic assessment of ethnic/racial minority patients. Few studies have investigated clinicians' methods of obtaining and using information during the initial clinical encounter. Previous studies have documented diagnostic bias and noted that its reduction could eliminate misdiagnosis and improve mental health service delivery.
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