Physicians tend to do more of the talking during exams when their patients are black, suggesting race plays a role in doctor-patient communication, says a study that analyzed recorded conversations inside doctors’ offices.
The study, published in this month’s issue of the American Journal of Public Health, is based on listening in on exam rooms for clues to why minorities tend to get lower-quality health care than whites.
Researchers at the Johns Hopkins Bloomberg School of Public Health found that physicians talked 43 percent more than their black patients and 24 percent more than their white ones. And they found the emotional tenor of conversations was more likely to be positive when patients were white.
“It doesn’t always have to be a bad thing,” said Dr. Lisa Cooper, a study co-author. “But we do know that the more verbally dominant the doctor is, the less satisfied the patient is.”
The study’s limitations make it impossible to know whether the findings can be applied nationally, the authors said. The report was based on data from 256 black and 202 white patients who visited 61 physicians in the Baltimore and Washington areas in 1998 and 2002.
But researchers said the findings suggest that teaching black 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 health gap between minorities and whites.
The issue has received increasing attention since a 2002 report from the Institute of Medicine, a non-profit government advisory arm. The report noted that minorities tend to receive lower-quality health care than whites, even when both groups have similar health insurance and incomes.
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 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 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.
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In total, 202 white patients and 256 black patients participated. Two-thirds were women, and the average age was 49.
Of the physicians, 30 were white, 21 were black, nine were Asian or American Indian, and one was classified as “other.”