Lack of Quality Communication During Medical Visits May Contribute to African-American Health Disparities

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 2004 issue of the American Journal of Public Health.

“Our study suggests that a lack of patient engagement and participation during medical visits may contribute to health disparities,” said Lisa A. Cooper, MD, MPH, senior author of the study and an associate professor in the Bloomberg School of Public Health’s departments of Epidemiology and Health Policy and Management.

The researchers analyzed audiotapes and questionnaire data from 458 patients who visited 61 physicians in the Baltimore, Md., 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,” said Dr. Cooper. “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.”

Dr. Cooper, who also holds an appointment with the Johns Hopkins University 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 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 affects health.

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, MD, PhD; Debra Roter, DrPH; Neil R. Powe, MD, MBA; and Lisa A. Cooper, MD, MPH.