White and African-American patients who see physicians
of the same race rate their medical visits as more
satisfying and participatory than do those who see
physicians of other races, even when the nature of the
conversation in both types of visits is similar, a Johns
Hopkins study finds.
Results of the study of audiotaped conversations
between physicians and patients showed that medical visits
between patients and physicians of the same race were two
minutes longer on average, and were characterized by
patients as having a more positive overall emotional tone
and higher satisfaction rating. The report is published in
the Dec. 2 issue of the Annals of Internal
Cooper, lead author of the study and associate
medicine and of
policy and management at Johns Hopkins, said people
tend to speak slower when they are more comfortable and
relaxed, which could account for the longer visit times in
race-concordant visits. "Even when the verbal content of
the visits was the same, perceptions of the visit were more
positive in race-concordant visits, suggesting that patient
and physician attitudes and expectations, rather than the
actual words used to communicate, may have affected
patients' experiences," Cooper said.
Teaching communication skills to physicians is
important to improve the patient-physician relationship,
she said. "However, this study suggests that simply
training physicians to make conversation in race-discordant
visits mimic that of race-concordant visits may not be
enough to improve patients' experiences in visits with a
physician of a different race. Increasing ethnic diversity
among physicians and engendering trust and comfort between
patients and physicians of different races may be the best
strategies to improve health care experiences for members
of ethnic minority groups."
For the study, Cooper and colleagues evaluated
physician-patient communication during the medical visits
of 252 patients (142 African-Americans and 110 whites)
receiving care from 31 physicians (18 African-Americans and
13 whites) at 16 primary care clinics in the Baltimore and
Washington metropolitan areas.
They approached patients in the waiting rooms and
asked for permission to tape record the medical visits.
Before the visit, patients completed a short survey about
their health status. After the visit, they completed
another survey that rated the physician's decision-making
style and asked about their overall satisfaction with the
visit and if they would recommend the physician to a
The audiotapes were analyzed for length of the medical
visit, speed of the patients' and physicians' speech, the
number of physician statements vs. patient statements, the
nature of the conversation (i.e., biomedical, psychosocial,
partnership-building, etc.), and the overall emotional tone
(friendliness, interest, responsiveness, engagement) of the
visit. Surveys were evaluated for the degree to which
physicians involve patients in medical decisions and
overall patient satisfaction.
Patients who visited physicians of the same race said
they were more involved in the decision process than those
who saw different-race physicians. Patients seeing
same-race physicians also had a higher probability of
saying they were satisfied with the visit and that they
would recommend the physician to a friend.
Members of other ethnic groups were not included in
this study because their representation in the clinical
sites visited was too small, Cooper said.
The study was supported by research grants from the
Commonwealth Fund, the Bayer Institute for Health Care
Communication and the Robert Wood Johnson Foundation.
Co-authors were Debra L. Roter, Rachel L. Johnson, Daniel
E. Ford, Donald M. Steinwachs and Neil R. Powe.
Related Web Sites
Johns Hopkins' Welch Center for Prevention, Epidemiology
and Clinical Research
Lisa Cooper's faculty page
Annals of Internal Medicine