Black patients say less to doctors, research suggests

Exam room study finds race plays role in communication

December 24, 2004|By Julie Bell | Julie Bell,Sun Staff

Physicians tend to do more of the talking during examinations when their patients are African-American, suggesting that race plays a role in how doctors and patients communicate, according to a new study that analyzes recorded conversations inside doctors' offices.

The study, published in this month's American Journal of Public Health, listened in on examining rooms for clues to why minorities tend to get lower-quality health care than whites, even when they have equal access to care.

Researchers at the Johns Hopkins Bloomberg School of Public Health, who conducted the study, found physicians talked 43 percent more than their black patients and only 24 percent more than their white ones. And they found that the emotional tenor of conversations -- on the part of both patients and physicians -- was more likely to be positive when patients were white.

"It doesn't always have to be a bad thing," Dr. Lisa Cooper, a study co-author, said of the finding that doctors talk more than patients. "But we do know that the more verbally dominant the doctor is, the less satisfied the patient is."

The study's limitations, including geographical issues, make it impossible to know if the findings can be applied to the nation as a whole, the authors said. The report was based on data from 458 African-American and white patients who visited 61 physicians in the Baltimore, Northern Virginia and Washington, D.C., areas in 1998 and 2002.

But researchers said the findings nonetheless suggest that teaching African-American patients how to better communicate with their doctors, as well as training physicians in how to engage their patients in conversation, might help narrow the well-documented gap between the health of minorities and whites.

The issue has received increasing attention since a 2002 report from the Institute of Medicine, a nonprofit government advisory arm. The report noted that minorities tend to receive lower-quality health care than non-minorities, even when both have similar health insurance and incomes.

Legislation last year required Maryland health officials to develop a plan to reduce disparities based on race, gender, ethnicity and poverty. Last summer, the University of Maryland School of Medicine established a Center for Health Disparities, aimed at promoting health care in urban and rural communities with concentrations of racial minorities and low-income whites.

A handful of large employers, including Verizon Communications and hotel giant Marriott International, also have begun initiatives to ensure minority employees understand and use the health benefits their companies offer.

Still, Cooper said, the new study breaks relatively unplowed ground by listening in on patients and doctors, to find out why patients may have different experiences based on their race.

"Why is it that people aren't referred or don't get certain treatments?" Cooper asked. "What's the nature of the communication that takes place?"

To find out, Johns Hopkins researchers got permission from patients and their doctors to tape record their conversations, then analyzed them using an established psychological methodology. Later, coders who didn't know the race of the patients or physicians listened to the conversations, categorizing everything that was said and documenting the emotional tone.

Researchers looked for the amount of time doctors and their patients spent in social, emotional and other rapport-building discussions, as well as time spent gathering data, such as how long a patient had been in pain. Those findings were further analyzed using information the patients had provided in a short survey about their own health status and demographics.

The study was limited to white and black patients, because there were not enough minorities of other racial or ethnic backgrounds to provide statistically meaningful results. Some 202 white patients and 256 African-American ones participated. Two-thirds were women, and the average age was 49.

Of the physicians, 30 were white, 21 were African-American, nine were Asian or American Indian, and one was classified as "other."

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