Physician–Patient Communication

Physician and Patient Characteristics

A plethora of research examines how physician– patient communication is affected by the genders of physician and patient in the interaction. Debra Roter and Judith Hall found that during physician– patient interactions, female patients receive more information and communication from physicians and generally have more overall participatory visits than male patients. Research suggests that female physicians make more positive partnership statements to their patients, ask more questions, engage in more “back-channel” communication (such as nodding or saying “um-hmm” to acknowledge hearing the patient), conduct longer visits, and inquire more about psychosocial issues than do male physicians. Overall, compared with males, female physicians engage more in communication about patients' lives, discuss emotional issues more, and allow patients to discuss a wider range of physical and psychosocial issues. Research also shows that same-sex physician–patient dyads tend to generate differing communicative patterns than opposite sex dyads; in male dyads the physician talks more than the patients, whereas in female dyads the amount of talk by both participants tends to be equal.

Age is also an important factor in physician– patient communication. Older patients (typically 65 years and older) seem to be less participatory than younger patients, but physicians spend more time with them and give them more information, perhaps because generally older patients have more biomedical issues to discuss. Physicians are more responsive nonverbally with middle-aged than older patients and are more egalitarian, less dominant, closer in interpersonal distance, use more shared and “back-channel” communication, and are more willing to adapt to the interactional interchange.

Ethnicity also plays a vital role in physician– patient communication. Race-concordant medical visits tend to last longer and are more satisfying to patients, and both physicians and patients talk at slower rates and are more participatory than in race-discordant visits. Research by Lisa Cooper-Patrick and colleagues has brought attention to disparities in communication between physicians with minority versus nonminority patients. Minority patients consistently rate their physicians as using less participatory decision making, and African American patients receive fewer opportunities for participation than do white patients. Research also indicates that physicians may unintentionally incorporate certain racial biases (that is, racial and ethnic stereotypes) into their interpretation of patients' symptoms, predictions of behavior, and medical treatment decisions. White patients have also been found to receive higher quality care, more empathic statements, more information, and more visit time than nonwhite patients.

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