The quality of medical care is a popular subject of debate, and oftentimes complaint. Sometimes gripes are legitimate and sometimes they’re not. But a new study finds that patients’ opinions of the care they receive can be quite different from the actual quality of the medical care. More alarming is that opinions and experiences vary greatly by race.

Researchers asked 374 women who had received treatment for early stage breast cancer at New York City hospitals about their opinions of the care they got. Just over half of the women (55%) said they received “excellent” care. But most women – 88% – actually got care that was considered in line with the best current treatment guidelines.

The process of obtaining medical treatment had a great influence on how satisfied patients were. Many women (60%) who said they got excellent care also said the process of getting the care was excellent; but only about 16% of women who said they got less-than-excellent care said the process of getting the care was excellent. This suggests that the ease or difficulty of obtaining the treatment in the first place has a big impact on one’s experience of the whole process.

The way the women felt they were treated by medical personnel also affected the total experience. Women who said they got “excellent” care were more likely to say they had good communication with their doctor, knew which person to go to with questions, and received excellent care by the medical staff in general. Importantly, they also felt less mistrust of the medical system overall.

Finally, another significant finding was that perception of treatment varied greatly by race. African-American women were less likely to report excellent care than Caucasian or Hispanic women, less likely to trust their doctor, and more likely to say they experienced racism during the process. There was, however, no difference in the actual quality of medical care they received, compared to Caucasian or Hispanic women.

The researchers suggest that, “something is being communicated to black women that results in their lower levels of trust and higher perceived racism. These sentiments vary among black women, which suggests that there are ways to redress this critical issue."

Making changes to improve the process of getting care – making appointments easier to arrange and test results simpler to obtain, for example – might make the process less unpleasant for patients. The researchers believe that this is doable and necessary.

The study was carried out at the Mount Sinai School of Medicine and Columbia University Medical Center, and published in the Journal of Clinical Oncology.