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Doctors Dominate Talks With Black Patients

They often don't seek their patients' opinions, study finds

MONDAY, Dec. 13, 2004 (HealthDayNews) -- In another apparent indication of racial disparities in the U.S. health-care system, a new study suggests doctors are more likely to dominate conversations with black patients.

The findings, based on reviews of thousands of tape-recorded office visits, also show that race appears to affect the level of personal warmth in doctor-patient relationships.

"In the visits of African-Americans, the patients sounded less happy, less engaged, less interested, and so did the doctors," said study co-author Dr. Lisa A. Cooper, an associate professor of health policy and management at Johns Hopkins School of Medicine.

Previous research has shown a wide divide between medical treatment for blacks and whites. A recent study by University of California, Los Angeles researchers reported that white doctors were less likely to promptly prescribe drug treatments to black AIDS patients.

"We've got two or three decades of research that has documented that ethnic minorities tend to receive fewer services and less appropriate services for a number of conditions," Cooper said.

In the new study, Cooper and her colleagues analyzed tape-recorded doctor visits involving 61 doctors and 458 patients in Washington, D.C., Baltimore, and northern Virginia. The visits took place in 1998 and 2002.

Thirty-one of the doctors were white, 20 were black and nine were of other races, Cooper said.

The researchers report their findings in the December issue of the American Journal of Public Health.

With black patients, the doctors were 23 percent more verbally dominant, according to the study. The ratio of physician comments to patient comments was 1.5 among whites -- meaning that doctors made three comments for every two patient comments -- and 1.7 among blacks.

"That suggests that in the visits of African-American patients, patients are talking less and asking fewer questions," Cooper said.

On another front, the researchers tried to gauge how well the doctors and patients interacted with each other. Among other factors, they looked at how often doctors asked questions about family and work, sought out the patient's opinion, and made expressions of concern or sympathy.

With black patients, the doctors were a third less likely to ask these types of questions and or to make these sorts of comments. The doctors were also less likely to use a "positive emotional tone," Cooper said.

So what's going on here? That's not clear. "We didn't ask people why they acted the way they did," Cooper said. "We just reported on that."

Dr. Winston Price, president of the National Medical Association, an organization of black doctors, said one issue could be an assumption by physicians that black patients are less educated. "Therefore, they tend to talk to those patients rather than communicate with them," he said.

There is some good news, though, Price noted. While the study suggested that inexperienced doctors may be more likely to treat black patients differently, young physicians are actually better prepared to deal with minorities, who often suffer from more than one illness. "Physicians coming out of training now are much better equipped to tackle patients with multiple conditions," he said.

Cooper said doctors should be more aware of the different ways they treat patients. "This is just a reminder to us to pay attention to our behavior and to think about what assumptions we're making about people when we interact with them, to raise our awareness of how our beliefs and attitudes might be influencing our behavior."

And while doctors may be partly to blame for poor communication, Cooper suggested that black patients can learn to do a better job of asserting themselves. They can "realize that it's OK to ask more questions and share more information, to give their opinions about what kinds of treatments they would prefer. Those are the big take-home messages."

More information

The U.S. Office of Minority Health has details about its efforts to improve and protect the health of racial and ethnic minority populations.

SOURCES: Lisa A. Cooper, M.D., M.P.H., associate professor, medicine, epidemiology, health policy and management, Johns Hopkins School of Medicine, Baltimore; Winston Price, M.D., president, National Medical Association, New York City; December 2004 American Journal of Public Health
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