Disparities/Minority Health

Race appears to be a factor in how doctors communicate with their patients during primary care visits

Lack of quality communication during primary care visits may contribute to disparities in health between blacks and whites, according to findings from a new study by researchers at the Johns Hopkins Bloomberg School of Public Health. They found differences in patient-physician communication during medical visits with white and black patients. Doctors were less likely to engage black patients in conversation, and the tone of visits with black patients generally was less friendly than with white patients. Poor doctor-patient communication may be partly to blame for health disparities, since more active participation of patients in conversations with their doctors has been linked to better treatment compliance and health outcomes, explains Rachel L. Johnson, M.D., Ph.D., lead investigator.

In a study that was supported in part by the Agency for Healthcare Research and Quality (F31 HS13265), Dr. Johnson and her colleagues analyzed audiotapes and questionnaire data from 458 patients who visited 61 physicians in the Washington, DC, metropolitan area in 1998 and 2002. They found that physicians tended to dominate conversations with black patients, with physicians talking 73 percent more than patients. In conversations with white patients, physicians talked 43 percent more than patients. Also, black patients and their doctors sounded less interested, engaged, and friendly, compared with conversations between white patients and their physicians.

The researchers recommend communication skills programs for medical students, residents, and practicing physicians that focus on patient-centeredness and how to build rapport with patients, which will benefit patients in general and racial/ethnic minority patients in particular. They also encourage physicians to more actively engage black patients in conversations about their health, so that they become more confident participants in their own health care. This, in turn, may help to reduce racial disparities in health status.

See "Patient race/ethnicity and quality of patient-physician communication during medical visits," by Dr. Johnson, Debra Roter, Dr.P.H., Neil R. Powe, M.D., M.B.A., and Lisa A. Cooper, M.D., M.P.H., in the December 2004 American Journal of Public Health 94(12), pp. 2084-2090.

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