Patient-Physician Communication and Race and Language Concordance: Is It More Important to Look or Sound Like Your Patient?

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BACKGROUND: The 2004 ACP position paper on Racial and Ethnic Disparities in Health Care states that ‘‘clear communication in clinical encounters is key to healthy patient outcomes, leading to greater patient satisfaction, and increased quality of care, which increases health-seeking behavior.’’ Increasing racial and linguistic concordance has been proposed as a way to improving patient-physician communication and thereby positively impact health outcomes. METHODS: The CCTOP Study (Cultural Competence Training and Outcomes in Patients) is a multi-center cross-sectional study of patients presenting for care at eleven outpatient medical centers. The study assessed physicians’ attitudes regarding culture and bias, as well as patients’ feelings regarding trust, communication and satisfaction with their physicians on five-point scales (1=strongly agree to 5=strongly disagree). RESULTS: Preliminary results were available from 291 patients (70% nonwhite) and their 175 physicians (44 attendings and 131 residents, 47% nonwhite) at the first 5 sites. Patients with physicians of the same race were more likely to consider their doctor courteous and respectful (1.2 vs.1.5, p=0.000), to understand their problems well (1.4 vs. 1.7, p=0.000), to communicate in words they understand (1.4 vs. 1.8, p=0.000), to listen to concerns and questions well (1.3 vs. 1.8, p=0.000), and to spend enough time with them (1.4 vs. 1.7, p=0.000). Patients with physicians of the same race were also more likely to say they were satisfied with their service (1.2 vs. 1.6, p=0.000). Patient-physician language concordance was not associated with improvement in any communication scores or overall satisfaction. Interestingly, neither racial nor linguistic concordance was associated with better patient-rated participatory communication scores. CONCLUSIONS: In this study, race concordance had a strong association with improved patient-physician communication scores independent of participatory communication scores and language concordance. These findings suggest that physician and patient attitudes may influence the patient-physician relationship to a greater degree than language concordance and ‘‘teachable’’ skills in patient-centered communication. This work supports assertions that strategies to diversify the physician workforce are a vital part of the plan to improve minority patient outcomes.

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Journal of General Internal Medicine





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(Oral presentation) Presented at the SGIM National Meeting, New Orleans, LA. May 12, 2005.