they received smaller prescriptions. It is our impression however this this patient group's size was not disparate. If anything, the Asian patients seemed to have a smaller body size, and yet they received prescription for more medication than did the Hispanics. Similarly, if the Hispanics did not speak English, this might account for their lower prescribed doses, although, here again, one might expect that the Asian patients would have had similar problems. In a basic sense the thesis of this chapter is that in order for pain to be treated effectively, there must be communication between doctor and patient. Cultural factors (certainly including language differences) influence this communication markedly. Even if it could be shown that our Hispanic patients did not speak English, our central observation would remain unchanged -- that physicians' appraisal of patients from a different cultural background affects their prescribing practices.
The findings of ethnic differences in prescription pattern of analgesic agents are compatible with an accumulating literature on this topic. The advantage of using a PCA for such studies is that one can begin to disentangle the patient's self-administering behavior from the physician's prescribing behavior. This study suggests that ethnicity exerts a prominent effect on physician's behavior, even when patient behavior is relatively constant across ethnic groups. Although other issues like the effectiveness of communication between physician and patient before the surgery, physician's ethnicity, and prior experience in treating pain still have to be considered, it seems clear that ethnicity has a profound influence on the physician's treatment plan.
The authors thank Kevie Naughton, Mark Wallace, M.D., and Charles Berry, Ph.D., for their assistance.
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