Race appears to be a factor in how doctors communicate
with their patients, according to a new study of primary
care visits conducted by researchers at the Johns Hopkins
Bloomberg School of
Public Health and
School of Medicine.
They found that doctors were less likely to actively
engage their black patients in conversation when compared
to the conversations they had with their white patients.
This finding is striking because other studies have shown
an important link between participation in medical visits
and better health care outcomes. The study is published in
the December issue of the American Journal of Public
"Our study suggests that a lack of patient engagement
and participation during medical visits may contribute to
health disparities," said Lisa A. Cooper, senior author of
the study and an associate professor in the Bloomberg
School's departments of
Epidemiology and of
Policy and Management.
The researchers analyzed audiotapes and questionnaire
data from 458 patients who visited 61 physicians in the
Baltimore, Washington, D.C., and Northern Virginia
metropolitan area in 1998 and 2002. The researchers found
that physicians talked 73 percent more than their black
patients and only 43 percent more than their white patients
— meaning the ratio of physician comments to patient
comments was higher during the visits of black patients. In
addition, African-American patients and their physicians
sounded less interested, engaged and friendly than did
white patients and their physicians.
"Our findings indicate that doctors may be talking
'at' their black patients and 'with' their white patients,"
Cooper said. "Additionally, if black patients talk less and
ask fewer questions when seeing physicians, that could
explain why they are less likely to report positive
experiences in health care. Past studies have shown that
patient-centered communication is associated with better
patient recall of information, treatment adherence and
satisfaction with care and health outcomes."
Cooper, who also holds an appointment with the School
of Medicine, explained that the mechanisms through which
race contributes to health disparities in health care in
the United States are complex and often obscure. She said,
"More research is needed, especially in the area of
quantifying the effect of differences in medical-visit
communications on clinical outcomes."
The Johns Hopkins researchers suggest in their study
that communication-skills programs for medical students,
residents and practicing physicians can benefit patients.
They also explain that physicians can build their
African-American patients' confidence by engaging them in
conversations during medical visits, thereby encouraging
them to participate in health care, which positively
The study authors were supported in part by grants
from the Commonwealth Fund; Bayer Institute for Health Care
Communications; National Heart, Lung and Blood Institute;
Agency for Health Care Research and Quality; and National
Institute of Graduate Medical Sciences.
Co-authors of the study from Johns Hopkins include
Rachel L. Johnson, Debra Roter, Neil R. Powe and Lisa A.