Communication in Health Care Visits when Doctors and Patients Have the Same versus Different Ethnic Backgrounds

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The summary below is from the full report titled "Patient-Centered Communication, Ratings of Care, and Concordance of Patient and Physician Race." It is in the 2 December 2003 issue of Annals of Internal Medicine (volume 139, pages 907-915). The authors are L.A. Cooper, D.L. Roter, R.L. Johnson, D.E. Ford, D.M. Steinwachs, and N.R. Powe.

What is the problem and what is known about it so far?

African-American patients who see African-American doctors report more involvement in medical decisions, higher trust, and higher satisfaction with their doctors than African-American patients whose doctors are not African American. A possible explanation for these differences is that doctors and patients communicate most effectively when they are of similar ethnic background. However, previous studies have not examined whether communication patterns differ when doctors and patients are of similar versus different ethnic backgrounds.

Why did the researchers do this particular study?

To compare patient–doctor communication during visits in which both the doctor and patient were African American or white with visits in which the doctor and patient did not share an ethic background.

Who was studied?

252 adults seeing 31 doctors in 16 primary care practices.

How was the study done?

The authors audiotaped each visit and then rated each tape using a standard process that measured whether the communication was more "patient centered" or "doctor centered." Compared with doctor-centered communication, patient-centered communication involved more opportunities for the patient to talk and to direct the conversation and greater effort to involve the patient in decision making. Before each visit, patients completed a survey that asked about their age, sex, race, education, and health. After each visit, patients completed a survey that asked them to rate whether the doctor encouraged them to participate in decision making, to rate their overall satisfaction, and to say whether they would recommend the doctor to a friend. The researchers then compared communication and satisfaction in 2 groups. The first group included visits in which both the doctor and patient were African American or both were white (race concordant). The second group included visits in which the patient was African American and the doctor was white or vice versa (race discordant).

What did the researchers find?

As in previous studies, this study found that patient ratings of care and of doctors' efforts to get the patient to participate in decisions were higher when both the doctor and patient were African American or both were white than when the doctor and patient had different backgrounds. In addition, visits were about 2 minutes longer and the patient's affect was more positive when the doctor and patient were of the same ethnic background. However, the researchers did not find that race-concordant visits had higher levels of patient-centered communication than race-discordant visits.

What were the limitations of the study?

This study included only African-American and white patients and doctors. The results may not apply to other or more specifically defined ethnic groups. In addition, the study was too small to find small differences in communication patterns.

What are the implications of the study?

Patient-centered communication does not seem to explain the favorable ratings of care for patients who see physicians whose ethnic background is similar to their own. Further research to understand the factors that explain these differences could help improve visits for all patients whether they see doctors with similar or different ethnic backgrounds.