- Spring 2005-

Lack of Communication May Contribute to African-American Health Disparities

Race appears to be a factor in how doctors communicate with their patients, according to a recent 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 a winter 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," says Lisa A. Cooper, M.D., 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, Washington, D.C. and Northern Virginia metropolitan area in 1998 and 2002. The researchers found that physicians talked 73% more than their black patients and only 43% 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," states 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 School of Medicine, explains that the mechanism through which race contributes to health disparities in health care in the United States is complex and often obscure. She says, "More research is needed, especially in the area of quantifying the effect of differences in medical-visit communications on clinical outcomes."

The Johns 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.