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September 22, 2009

Doctor Visits: Race Matters

African American patients tend to have less informative communication with their healthcare providers than do whites. The good news is that patients..

Communication with one’s doctor is crucial to good healthcare. It has long been known that, the likelihood of having poorer−than−average communication with your doctor is higher if you are in ill health. Now, a new study adds the dimension of race. The study set out to measure communication differences among patients with high blood pressure during visits to doctor.

In the study, ill patients were those with uncontrolled high blood pressure, while well patients were those who had their blood pressure under control.

Whatever is causing the communication problems, it can't be good for the health of black patients.

The study found that overall communication between African American patients and their doctor was poorer than that between white patients and their doctor. Interestingly, it found no significant communication differences between doctors and their ill and well white patients. Clearly there's a failure to communicate here. And it's along racial lines.

The study looked at the visits of 226 patients to 39 different doctors and focused on the length of the visits and the numbers of various types of statements exchanged between doctor and patient. Less of any measure was viewed as reflecting worse communication. While it is possible to argue that less communication simply means more efficient communication, the researchers do not take this view. They point out that historically, blacks report lower adherence to the blood pressure control measures prescribed by their doctor than whites do.

According to lead researcher Crystal W. Cené, "It seems that in general blacks talk less overall to their physicians than white patients. As a result, communication about specific topics occurs less often. There are several possible reasons why they may talk less to their physicians—they might not trust the physician or feel that they are 'disconnected' from their doctors, for whatever reasons. This lack of communication by black patients may in turn make their physicians talk less to them."

Whatever is causing the communication problems, it can't be good for the health of black patients. As a result of the reduced communication with their healthcare providers, they likely leave doctor visits with less detailed information about how to treat their condition than they should. Doctors, too, are likely to receive too little information from their black patients to offer the best help they can.

The study authors recommend testing any interventions that might improve the situation. Specifics measured during the study, which relied on audiotapes of doctor−patient visits, included patient visit length and the number of biomedical, psychosocial and rapport−building statements that were made during the visits. The lessened communication of black patients relative to whites was statistically significant for psychosocial exchange and rapport building but not for biomedical exchange.

The study initially set out to find whether both being black and having poor blood pressure control adversely affected communication more than either condition alone did (double jeopardy). It found double jeopardy occurring only for patient positive affect—a combination of the patients' interest, friendliness, engagement, sympathy and assertiveness.

Along the way, it found that race worsens communication more than illness does, at least in the case of blood pressure control.

Crystal Wiley Cené, M.D., M.P.H., is an assistant professor in the Division of Internal Medicine at the University of North Carolina at Chapel Hill. The study was done in conjunction with colleagues at Johns Hopkins University’s Bloomberg School of Public Health and was published in the September 2009 issue of the Journal of General Internal Medicine.

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