The social gradient in doctor-patient communication

Int J Equity Health. 2012 Mar 12:11:12. doi: 10.1186/1475-9276-11-12.


Objective: In recent years, the importance of social differences in the physician-patient relationship has frequently been the subject of research. A 2002 review synthesised the evidence on this topic. Considering the increasing importance of social inequalities in health care, an actualization of this review seemed appropriate.

Methods: A systematic search of literature published between 1965 and 2011 on the social gradient in doctor-patient communication. In this review social class was determined by patient's income, education or occupation.

Results: Twenty original research papers and meta-analyses were included. Social differences in doctor-patient communication were described according to the following classification: verbal behaviour including instrumental and affective behaviour, non-verbal behaviour and patient-centred behaviour.

Conclusion: This review indicates that the literature on the social gradient in doctor-patient communication that was published in the last decade, addresses new issues and themes. Firstly, most of the found studies emphasize the importance of the reciprocity of communication.Secondly, there seems to be a growing interest in patient's perception of doctor-patient communication.

Practice implications: By increasing the doctors' awareness of the communicative differences and by empowering patients to express concerns and preferences, a more effective communication could be established.

Publication types

  • Review

MeSH terms

  • Acculturation
  • Affective Symptoms
  • Communication*
  • Cultural Diversity
  • Health Status Disparities
  • Humans
  • Models, Statistical
  • Patient-Centered Care
  • Physician-Patient Relations*
  • Social Behavior*
  • Social Class*
  • Social Participation
  • Verbal Behavior*