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Personal Awareness and Effective Patient Care-Reply

Dennis H. Novack, MD; William Clark, MD; Richard Frankel, PhD
JAMA. 1997;278(20):1658. doi:10.1001/jama.1997.03550200034019.
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In Reply  —We derived our statement about Indian and Pakistani residents' training from a qualitative study of international medical graduates, coauthored by a member of our working group.1 The study illustrated how cultural differences may act as barriers to patient care and reflected the opinions of Indian and Pakistani residents in a single program. We apologize for what may have been an overgeneralization. We certainly meant no offense to our Indian and Pakistani colleagues.We made no claims to scientific proof that particular physician personal qualities "caused" certain behaviors. We cited studies to substantiate our assertion that physician personal factors affect patient care. Nightingale and Grant2 reported strong associations between physicians' attitudes toward risk and their use of certain health care resources, preferences for intubation, and the duration of resuscitation efforts. Physician gender affects clinical decisions. The presence of a cautionary statement in 1 of our 12 citations on gender


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