Patient race and psychotropic prescribing during medical encounters

This paper examines how patient race, rating of physical and emotional health, expression of physical, emotional, and social problem symptoms, and physician perceptions of patients' physical health, emotional health, and social problems influence psychotropic prescribing in patients with chronic illness. Data were collected at 11 geographic areas in the United States and Canada. Patient visits were audio-tape recorded and research assistants interviewed each patient after their medical visit. Physicians completed self-administered questionnaires after each visit with a participating patient. Whites were significantly more likely to receive psychotropic prescriptions than non-whites (P < 0.05). Twenty percent of white and 13.5% of black patients received prescriptions for one or more psychotropic medications. Logistic regression techniques were used to predict psychotropic prescribing to white and non-white patients respectively. Patient expression of emotional symptoms and physician perceptions of patient emotional health significantly influenced psychotropic prescribing to white patients, whereas only patient expression of emotional symptoms significantly influenced psychotropic prescribing to non-white patients. Patient expression of physical and social problem symptoms and physician perceptions of patient physical health and social problems did not influence psychotropic prescribing to white or non-white patients. The paper emphasizes the importance of training primary care physicians to probe and to provide patients with an opportunity to discuss their emotional symptoms.