Vulnerable Patients and the Primary Care Visit

The process of provider-patient communication

    • September 12, 2013

To investigate health care disparities, M. Robin DiMatteo, PhD, and a team of researchers at the University of California-Riverside, examined links between patient vulnerability and physician–patient communication during primary care visits.

Dates of Project: April 2006 to September 2009

Description: Disparities in health status, treatment, and outcomes related to patients’ race, ethnicity, and socioeconomic status persist in the United States. Some of these disparities may reflect the way health providers and vulnerable patients communicate, both verbally and nonverbally, during medical visits.

M. Robin DiMatteo, PhD, and her research team analyzed audiotapes of 2,197 primary care visits at a university medical center, a health maintenance organization, and a Veterans Administration clinic in southern California in the late 1990s. After each visit, physicians and patients completed detailed questionnaires. The research team also analyzed other studies of communication between providers and vulnerable patients. The researchers published their findings in articles and book chapters.

“Communication is not as good as it needs to be with all patients, but especially vulnerable ones.”—Robin DiMatteo, PhD, project director

Key Findings

  • Nonminority male primary care physicians communicate with male and female African-American patients differently—and those differences tend to disadvantage African-American women.

  • The use of humor varied significantly with patients’ socioeconomic status.

  • Mutual trust was stronger between physicians and high-income patients than between physicians and low-income patients.

  • Vulnerable older patients receive less information about their health, and less counseling on health-related behavior, during primary care visits.

  • Patients who are minority and poor, and have low levels of health literacy and education, are not heard in medical visits. Without a sense of empowerment in medical interactions, these patients are unable to advocate not only for themselves but also for all patients at organizational, community, and national levels.

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Minority & poor patients who have less education & low health literacy are not heard in medical visits