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The newspaper of The Johns Hopkins University December 15, 2003 | Vol. 33 No. 15
Blacks, Whites Rate Their Care Better When Seeing Same-Race Physicians

Whites, African-Americans rate care experiences better with same-race docs

By Karen Blum
Johns Hopkins Medicine

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 Medicine.

Lisa A. Cooper, lead author of the study and associate professor of medicine and of health 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 friend.

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


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