Black patients seen, not heard

UNC-CHAPEL HILL (US) — A new study finds black patients with high blood pressure talk less overall to their doctors than white patients, which may make physicians talk less about specific topics to them, leading to worse health outcomes.

“This is an important finding because poorer communication is associated with worse patient satisfaction, adherence to therapy, and blood pressure control, which in turn may lead to worse disease outcomes for black patients compared to white patients,” explains lead author Crystal Wiley Cené, assistant professor in the University of North Carolina at Chapel Hill School of Medicine.

“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,” Cené says.

Cené’s study was part of a larger one aimed at improving patient adherence to high blood pressure therapy. She analyzed audio recordings of patient visits with their primary care physician to examine whether having uncontrolled blood pressure, in addition to being black, had a greater negative impact on patient-doctor communication than just race alone.

Earlier studies have already shown that patients in poor health have worse interpersonal relationships with their doctors and that black patients’ report poorer patient-doctor communication than white patients.

Participants in Cane’s study included 226 high blood pressure patients and 39 physicians from 15 primary care practices in Baltimore. The researchers listened to recordings of the patient visits and found that black patients had shorter office visits, less biomedical and psychosocial exchange, and less rapport building with their doctors than white patients.

Further, blacks patients with uncontrolled high blood pressure fared somewhat worse than those whose blood pressure was controlled by medication. There was no significant differences among whites based on blood pressure control status.

The researchers found that for each outcome black patients, regardless of whether their blood pressure was controlled or not, had worse communication with their doctors than whites, regardless of the white patients’ blood pressure control.

The only exception was for an outcome called “patient positive affect,” which is a sum rating of patients’ interest, friendliness, engagement, sympathy, and assertiveness. For this outcome they found that black patients with uncontrolled blood pressure had less positive affect than any of the other groups.

“We believe there also may be an ‘unspoken subtext’ that occurs in visits between patients and doctors that influences the communication that occurs during the visit,” Cane explains. “It’s possible that black patients are more likely to pick up on that ‘unspoken subtext’ and it alters their communication with their doctor. Essentially they are more sensitized to ‘cue’ into things.”

The study concluded that patient race was more important than blood pressure control status in determining the quality of patient-doctor communication and recommended the testing of interventions designed to improve patient-doctor communication as a way to reduce racial disparities in the care of patients with high blood pressure.

The study appears in the September issue of the Journal of General Internal Medicine.

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