A White Therapist, an African American Patient—Shame in the Therapeutic Dyad: Commentary on Paper by Neil Altman

Neil altman's candid sharing of this daunting case reveals a courage and openness too rarely encountered. It is difficult to talk honestly about race when our feelings depart from “correctness.” Such a dialogue is long overdue.

Although some liberal bias may exist in many centers of professional training, the professional, like everyone else, is profoundly shaped by the culture's constructions of reality. A disturbing example of such influence is provided by a recent Georgetown University study. Experimenters (Schulman et al., 1999) sought to determine the role of physician decision-making in race and sex differences found in the treatment of cardiovascular disease. A group of 720 primary care physicians were given simulated patient protocols from which they were to determine need for further cardiac diagnostic procedures. Cardiac catheterization is considered the most sophisticated and useful of these procedures, “the best way to diagnose coronary artery disease and to decide whether to perform cardiac surgery” (Goldstein, 1999, p. A13). Effects of six variables were assessed: patient gender, race, age, level of coronary risk, type of chest pain, and results of an exercise stress test. Interviewed “patients” (videotaped actors) read from identical scripts, wore identical clothes, and had the same symptoms, insurance, occupations, and risk factors.

Catheterization was recommended for blacks (both male and female) 60 percent as often as it was prescribed for whites (male and female).