The Commonwealth Fund's 2001 Health Care Quality Survey found evidence that African-American patients visiting white physicians report less participation in decision making, lower levels of trust and lower levels of satisfaction with their health care. The authors of this study hypothesized that race concordance (black doctors seeing black patients, and white doctors seeing white patients) is associated with higher levels of patient centered communication, higher patient ratings of physician's participatory decision making and higher ratings of patient satisfaction. They conducted a cohort study involving 16 urban primary care practices, wherein they asked participants to tape record pre-visit self-assessments of health status and post-visit assessments of physician style, their satisfaction with the visit and whether they would recommend the physician to a friend. Meanwhile, physicians completed background surveys and surveys about how well they knew each patient participant. In all, 31 physicians (13 white and 18 African-American) and 252 patients of both races participated. Race concordant visits were slightly longer and had slightly higher mean ratings of positive patient effect than race discordant visits. The authors suggest several limitations requiring consideration when drawing conclusions from their work. Unmeasured factors could have influenced the findings, the study is limited geographically to the D.C.-Baltimore area and findings are not generalizable to other racial and ethnic minority groups. Nevertheless, this is one of the first studies to link race concordance between African-American and white physicians and their patients to directly observed communication and patient-reported visit outcomes.