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Michelle Sharp, MD

Blogger: Michelle Sharp, MD

About the blogger: Michelle Sharp is currently a Pulmonary & Critical Care Medicine Fellow at Johns Hopkins, where she completed her residency training and served as an Assistant Chief of the Osler Medical Service. Her research interests are in evaluation and improvement of patient-physician communication with a focus on health disparities and health literacy.


Citation: Shen, M.J., et al. The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature. Journal of racial and ethnic health disparities (2017).

Article: The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature

Summary: The authors’ goal in this systematic review was to evaluate the literature on the effect of patient race and patient-physician racial concordance on patient-physician communication, as measured observationally or through patient-reported outcomes in diverse clinical settings. The review evaluated 40 articles and summarized the findings over eight domains: 1) communication quality, 2) communication satisfaction, 3) information-giving, 4) partnership building, 5) patient participation and participatory decision-making, 6) positive and negative affect of physicians in clinical interaction 7) length of visit and talk-time ratio of patient to physician, and 8) other.

A third of the outcomes found that patient race did not have an impact on patient-physician communication, however, more than half of the outcomes reported lower patient-physician communication quality and satisfaction domains among black patients versus white patients. Variability of results was attributed to heterogeneity of methods, clinical setting subspecialties, and outcome measures. In broader measures evaluating patient-physician communication, black patients report better quality of communication than white patients. However, in more specific measures of communication such as interpersonal exchange, fairness, and respect black patients report worse quality of communication compared to white patients. Racial discordance was found to predict poorer communication in all domains except quality of communication in 11 out of 12 studies.

Why this article:
High quality patient-centered or family-centered communication is linked to improved patient satisfaction, patient adherence, and patient outcomes.1-4 Poor communication among minority patients has also been linked with worse patient adherence and health outcomes,5,6 which contributes to health disparities. Communication skills, should be taught as any other learnable skill such as performing bronchoscopy. This may be especially important in high stress ridden environments such as the intensive care unit. It is important as educators to evaluate trainees’ communication skills and provide trainees with feedback for improvement. This should include interactions with patients among diverse ethnic and racial backgrounds.

  1. Ha, J.F. & Longnecker, N. Doctor-patient communication: a review. The Ochsner journal 10, 38-43 (2010).
  2. Hall, J.A., Roter, D.L. & Rand, C.S. Communication of affect between patient and physician. Journal of health and social behavior 22, 18-30 (1981).
  3. King, A. & Hoppe, R.B. “Best Practice” for Patient-Centered Communication: A Narrative Review. Journal of graduate medical education 5, 385-393 (2013).
  4. Zolnierek, K.B. & Dimatteo, M.R. Physician communication and patient adherence to treatment: a meta-analysis. Medical care 47, 826-834 (2009).
  5. Cene, C.W., Roter, D., Carson, K.A., Miller, E.R., 3rd & Cooper, L.A. The effect of patient race and blood pressure control on patient-physician communication. J Gen Intern Med 24, 1057-1064 (2009).
  6. Kaplan, S.H., Greenfield, S. & Ware, J.E., Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Medical care 27, S110-127 (1989).