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Cited by 584Patient-Provider Communication in HealthcareInterpreting and Communication in HealthcareEmpathy and Medical Education

Socio-economic status of the patient and doctor–patient communication: does it make a difference?

Open access
Willems, S., De Maesschalck, S., Deveugele, M., Derese, A., De Maeseneer, J.·2005·Patient Education and Counseling
DOI 10.1016/j.pec.2004.02.011
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Abstract

This systematic review, in which 12 original research papers and meta-analyses were included, explored whether patients' socio-economic status influences doctor-patient communication. Results show that patients from lower social classes receive less positive socio-emotional utterances and a more directive and less participatory consulting style, characterised by significantly less information giving, less directions and less socio-emotional and partnership building utterances from their doctor. Doctors' communicative style is influenced by the way patients communicate: patients from higher social classes communicate more actively and show more affective expressiveness, eliciting more information from their doctor. Patients from lower social classes are often disadvantaged because of the doctor's misperception of their desire and need for information and their ability to take part in the care process. A more effective communication could be established by both doctors and patients through doctors' awareness of the contextual communicative differences and empowering patients to express concerns and preferences.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review of 12 studies found that lower-SES patients receive less information, less participatory/patient-centred communication, and more directive care, partly because their own communication style elicits less information. The authors conclude that lower-educated patients are “doubly disadvantaged” by a more passive communicative style and by physicians’ misperceptions of their desire and need for information.

Key findings

  • Lower social class patients receive significantly less positive socio-emotional utterances, a more directive and less participatory consulting style, less involvement in treatment decisions, a higher percentage of biomedical talk and physician question asking, lower patient control over communication, less diagnostic and treatment information, and more physical examination.
  • In Hall et al.’s meta-analysis (55 articles on 41 studies, 1967–1986), higher patient social class was positively related to information giving; for information giving, the reported statistic was “maximum r/study, mean Z 2.39, p < 0.01.”
  • Street et al. found that more educated patients received more diagnostic and health information (pr = 0.38; p < 0.05) and more partnership-building utterances (pr = 0.50; p < 0.01); in a paediatric study, more educated parents asked more questions (pr = 0.24, p < 0.02).
  • Pendleton et al. found a significant difference in voluntary explanations given to patients from different social classes (F Ratio 4.04; p < 0.025), with higher SES patients receiving significantly more explanations even when not explicitly requested. Kaplan et al. (8316 patients) found patients with high school education or less were significantly less involved in treatment decisions, less given a sense of control, and less asked to take responsibility for care than patients with post-graduate college education.

Methods

  • Systematic literature review searching MEDLINE and PsycINFO (1965–2002) with MeSH and text-word keywords on doctor–patient communication and social class/SES; 42 articles were identified and references checked for additional relevant articles.
  • Inclusion required articles mentioning the interaction between patient SES (education, income, or occupation) and determinants of doctor–patient communication; articles using only proxy SES variables (e.g., race, gender, health literacy) and non-original research, opinion articles, and reviews were excluded. After exclusion, 12 articles were compared.
  • Communication variables were clustered into verbal instrumental behaviour, verbal affective behaviour, non-verbal behaviour, and patient-centred behaviour; the review compared results across studies rather than conducting a quantitative meta-analysis.

Limitations

  • Stated by the paper: the limited number of studies on this topic, and even fewer studies investigating the link between patient SES and affective and non-verbal physician behaviour; comparison of results was difficult because of great diversity in measurements and frameworks, and many different communication classification systems were not always comparable.
  • Stated by the paper: Martin et al. had an important restriction because patients from lower social classes were underrepresented.
  • Evident from the text: the review included only 12 articles, the search ended in 2002, and the heterogeneity of communication variables precluded a clear quantitative summary; some findings rely on physicians’ perceptions rather than patient-shared perceptions.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.pec.2004.02.011

Cites

73 of 73 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 51 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Higher morbidity and mortality rates for the socioeconomically disadvantaged are still found.

    “In spite of marked health improvements of the overall population and efforts to overcome health inequalities, higher morbidity and mortality rates for the socioeconomically disadvantaged are still found.(1, 2, 3, 4)”
    Quote in the paperSubstantial claim2 of 4 sources checked
    • cites [1] Proceedings of the Conference of WHO 50th Anniversary Congress, 1998.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [2] Lynch, 2001, Income inequality, the psychosocial environment, and health: comparisons of wealthy nations, Lancet source

      The Conclusions (page unavailable) state that within countries, lower income is a powerful determinant of poorer health, supporting the claim’s general socioeconomic gradient. Our copy does not specifically establish that disadvantaged people have higher rates of both morbidity and mortality, so it does not support that full formulation. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [3] Turrell, 2001, Socio-economic inequalities in all-cause and specific-cause mortality in Australia: 1985–1987 and 1995–1997, Int J Epidemiol source

      The Mortality rates section reports that, despite overall declines from 1985–1987 to 1995–1997, death rates remained typically highest in the most disadvantaged Australian areas. The paper examines mortality, but the passages do not establish higher morbidity rates; that part of the claim is unsupported. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [4] Mackenbach, 1994, A prospective cohort study investigating the explanation of socio-economic inequalities in health in The Netherlands, Soc Sci Med source
  • Premisecitation

    McKinstry found lower social class predicted lower preference for shared decision making style (odds ratio 0.35 (0.13-0.94) for highest social class and 1.05 (0.54-2.02) for lowest social class).

    “Also a lower social class predicted a lower preference for shared decision making style (odds ratio 0,35 (0,13-0,94) for the highest social class and 1,05 (0,54-2.02)for the lowest social class).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [34] McKinstry, 2000, Do patients wish to be involved in decision making in the consultation? A cross-sectional survey with video vignettes, BMJ source
  • Findingcitation

    There is large interindividual variation in the physicians' degree to which he provides information, issues directives, exhibits positive socio-emotional behaviour and engages in partnership-building.

    “Finally, although not immediately related to the patients' social class, we mention the large interindividual variation in the physicians' degree to which he provides information, issues directives, exhibits positive socio-emotional behaviour and engages in partnership-building.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Street, 1992, Communicative styles and adaptations in physician–parent consultations, Soc Sci Med source
  • Findingcitation

    Doctors behave differently during consultations with patients from lower social classes.

    “Doctors behave differently during consultations with patients from lower social classes.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Fiscella et al. conclude that for patients with lower education, slightly larger proportion of consultation was spent on physical examination and nutritional counselling.

    “In a survey among 2538 visits in primary care in New York, Fiscella et al. conclude that for patients with lower education (high school or less) a slightly larger proportion of the consultation was spent on physical examination and nutritional counselling.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Fiscella, 2002, Does patient educational level affect office visits to family physicians, J Natl Med Ass
  • Classified as probably not a substantial claim. 20
  • May combine two claims. 15

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Causes of socio-economic health inequalities are multiple and complex and include individual factors, structural factors, unequal distribution of risk factors, and inequalities in accessibility of health care.

    “The causes are multiple and complex and include individual factors such as personal history (e.g.childhood SES and living conditions) and education, structural factors such as income and housing facilities, unequal distribution of risk factors in the population and inequalities in the accessibility of health care.(5)(6)(7)(8)(9)(10)(11)(12)”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [5] Power, 1997, Origins of health inequalities in a national population sample, Lancet source
    • cites [6] Benzeval M, Judge K, Whitehead M. Tackling inequalities in health. London: King’s Fund; 1995.
    • cites [7] Van de Mheen, 1998, Does childhood socioeconomic status influence adult health through behavioural factors?, Int J Epidemiol source

      The Discussion reports that childhood socioeconomic circumstances affect adult health and health-related behaviour, while behaviour explains only about 10% of the health differences studied. It also considers cumulative disadvantage and other pathways. The paper does not support the full list of causes in the citing sentence, particularly unequal access to health care and housing facilities. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    More educated patients communicate more actively (ask more questions, are more opinionated) and show more affective expressiveness, eliciting more information from their physician.

    “More educated patients communicate more actively (they ask more questions, are more opinionated) and show more affective expressiveness, eliciting more information from their physician.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [25] Street, 1991, Information giving in medical consultations: the influence of patients communicative styles and personal characteristics, Soc Sci Med source
    • cites [26] Street, 1992, Communicative styles and adaptations in physician–parent consultations, Soc Sci Med source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Articles were included when they mentioned the interaction between SES of the patient or its determinants (education, income, occupation) and determinants of doctor-patient communication.

    “To make the comparison of results possible, articles were included when they mentioned the interaction between the SES of the patient or one of it's determinants (educational level, income or occupation) as well as determinants of doctor-patient communication.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Articles determining SES by variables other than education, income or occupation were excluded.

    “Articles determining SES by other variables than education, income or occupation (e.g.race, gender, health literacy) were excluded.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    After exclusion, 12 articles were used to compare results.

    “After exclusion, 12 articles were used to compare results.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    MEDLINE and PsycINFO (1965-2002) were searched using specified keywords.

    “MEDLINE and PsycINFO (1965PsycINFO ( -2002) ) were searched, using the following keywords:”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Explanations for socio-economic inequalities in health remain largely unclear.

    “Explanations for these inequalities in health are often explored but remain largely unclear.(4, 5)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [4] Mackenbach, 1994, A prospective cohort study investigating the explanation of socio-economic inequalities in health in The Netherlands, Soc Sci Med source
    • cites [5] Power, 1997, Origins of health inequalities in a national population sample, Lancet source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Important determinants for compliance are mainly more information giving, more positive talk and empathy, and an increased participatory style.

    “The important determinants for compliance are mainly more information giving, more positive talk and empathy and an increased participatory style.(13,17,18,20)”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [13] Stewart M, Roter D. Which facets of communication have strong effects on outcome—a meta-analysis. Communicating with medical patients. Newburry Park: Sage Publications; 1989.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [17] Squier, 1990, A model of empathic understanding and adherence to treatment regimens in practicioner–patient relationships, Soc Sci Med source
    • cites [18] Buetow, 1995, What do general practicioners and their patients want from general practice and are they receiving it?, Soc Sci Med source
    • cites [20] Lassen, 1991, Connections between the quality of consultations and patient compliance in general practice, Fam Pract source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Articles that were not original research articles, opinion articles and reviews were excluded.

    “Articles that were not original research articles, opinion articles and reviews were excluded.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In Street et al. second study, more educated parents are more expressive, have higher level of being opinionated, and ask more questions (pr=0.24, p<0.02).

    “In this study it becomes clear that more educated parents not only are more expressive and have a higher level of being opinionated but they also ask more questions (pr = 0.24, p < 0.02).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Street, 1992, Communicative styles and adaptations in physician–parent consultations, Soc Sci Med source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Communicative behaviour can be categorised following the axis verbal/non-verbal behaviour.

    “We considered several communication assessment approaches to cluster these variables.(22,23) Communicative behaviour can be categorised following the axis verbal/non-verbal behaviour.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [22] Ong, 1995, Doctor–patient communication: a review of the literature, Soc Sci Med source
    • cites [23] ACGME Outcome project. Interpersonal and communication skills assessment approaches; 2001. Ref Type: Data File.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Taira et al. found that among patients at risk, physicians tended to discuss diet and exercise more with high income patients and smoking more with low income patients.

    “Concerning patients at risk, physicians tended to discuss diet and exercise more with high income patients and smoking more with low income patients.(18)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Buetow, 1995, What do general practicioners and their patients want from general practice and are they receiving it?, Soc Sci Med source

  • May combine two claims.

    Premisecitation

    Less time was spent on less educated patients' questions, assessing health knowledge, negotiating and counselling, and less screening tests were provided to them.

    “Less time was spent on patient's questions, assessing their health knowledge, negotiating and counselling, and less screening tests were provided to them.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Fiscella, 2002, Does patient educational level affect office visits to family physicians, J Natl Med Ass

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Comparison of results of selected studies was difficult due to great variation in communication variables tested.

    “The comparison of the results of the selected studies was difficult, given the great variation in communication variables that had been tested.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Both verbal and non-verbal behaviour of physicians during consultation seem to correlate positively with patient satisfaction.

    “When looking at the impact of components of physicians' behaviour during consultation, both verbal behaviour and non-verbal behaviour seem to correlate positively with patient satisfaction.(13,14,15,16)”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [13] Stewart M, Roter D. Which facets of communication have strong effects on outcome—a meta-analysis. Communicating with medical patients. Newburry Park: Sage Publications; 1989.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [14] Smith, 1981, Characteristics of the initial medical interview associated with patient satisfaction and understanding, J Fam Practice

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [15] Bensing, 1991, Doctor–patient communication and the quality of care, Soc Sci Med source
    • cites [16] Buller, 1987, Physicians’ communication style and patient satisfaction, J Health Soc Behav. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Most used communicative variables could be categorised following axis verbal/non-verbal behaviour.

    “We were able to categorise most of the used communicative variables following the axis verbal/non-verbal behaviour.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The variables used in these classifications are not always comparable, making creation of clear overview difficult.

    “The variables used in these classifications are not always comparable, making the creation of a clear overview difficult.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The number of articles investigating the link between patients' SES and affective and non-verbal behaviour of physician is even more limited.

    “Even more limited is the number of articles investigating the link between the patients' SES and the affective and non-verbal behaviour of the physician.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    In selected articles many different communication classification systems were used to describe communicative behaviour of physician.

    “In the selected articles many different communication classification systems were used to describe the communicative behaviour of the physician.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Determinants of communication that did not fit into categories of this axis were related to patient centredness.

    “The determinants of communication that did not fit into the categories of this axis, were related to patient centredness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Patients with higher education experience a smaller cultural distance between them and the doctor due to similar background, so they might have fewer difficulties interacting with physician.

    “Because patients with a higher education experience a smaller cultural distance (due to a similar background) between them and the doctor, they might have fewer difficulties when interacting with the physician.(25)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Street, 1991, Information giving in medical consultations: the influence of patients communicative styles and personal characteristics, Soc Sci Med source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    An important limitation of this review is the limited number of studies on this specific topic.

    “An important limitation the researchers were confronted with when writing this review, is the limited number of studies on this specific topic.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Premisenone given

    Occupational status reflects both education and income aspects and adds benefits such as prestige, privileges, social and technical skills and power.

    “The occupational status reflects both these aspects and adds benefits that can accrue from certain jobs, like prestige, privileges, social and technical skills and power.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Kaplan et al. found patients with high school education or less were significantly less involved in treatment decisions, less given sense of control, and less asked to take responsibility for care than patients with post-graduate college education.

    “The results indicate that patients with a high school education or less were significantly less involved in treatment decisions, less given a sense of control over treatment decisions and less asked to take responsibility for care than patients with post-graduate college education.(33)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Kaplan, 1995, Patient and visit characteristics related to physician’s participatory decision making style, Med Care source

  • May combine two claims.

    Interpretationreasoning

    Physicians often ground their behaviour on these perceptions, but this is not always in accordance with reality.

    “Even though physicians often ground their behaviour on these perceptions, this is not always in accordance with reality.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Patients with a lower educational level are doubly disadvantaged: first because of their more passive communicative style and secondly because of the physicians' misperception of their desire and need for information.

    “In conclusion, patients with a lower educational level are doubly disadvantaged: first of all because of their more passive communicative style and secondly because the physicians' misperception of their desire and need for information.(25)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Street, 1991, Information giving in medical consultations: the influence of patients communicative styles and personal characteristics, Soc Sci Med source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisereasoning

    Educational level is used as a measure because differences in education correspond with different access to information and with different levels of benefiting from new knowledge.

    “Educational level is used as a measure because differences in education correspond with different access to information and with different levels of benefiting from new knowledge.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisereasoning

    Income is another possible parameter for social class as it creates differences in access to scarce material goods.

    “Income is another possible parameter for social class as it creates differences in access to scarce material goods.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    It is very difficult to compare results of existing studies or make a summary due to great diversity of measurements and frameworks.

    “Besides this it is very difficult to compare the results of the existing studies, or even to make a summary due to the great diversity of measurements and frameworks organising these measurements in the different studies.”
    Quote in the paperSubstantial claim
29 of 29

  • The paper relies on this without support.

    Quality of communication between the patient and his/her health care provider is an important determinant of accessibility to health care.

    “An important determinant of accessibility to health care is the quality of the communication between the patient and his/her health care provider(s).”

  • The paper relies on this without support.

    Doctor-patient communication has never been included in any explanatory model for socio-economic health inequalities.

    “Yet this factor has to our knowledge never been included in any of the explanatory models for socio-economic health inequalities.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Willems et al found that patients with lower SES had a less positive dialogue with their doctor, characterised by lower levels of information giving, less interactive discourse and a lower level of doctor advice/instruction.

    “Willems et al 12 found that patients with lower SES had a less positive dialogue with their doctor, characterised by lower levels of information giving, less interactive discourse and a lower level of doctor advice/instruction.”

    From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [12]

    The Conclusions (§4.1; page unavailable) report less information and less participatory communication with lower-SES patients. The Verbal behaviour section (§3.1.1; page unavailable) reports that doctors said they gave these patients less advice, but the review does not establish a lower level of instruction; its conclusion instead describes a more directive consulting style. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • A meta-analysis is included despite the exclusion rule

    Minor

    The methods say reviews were excluded, yet the results discuss Hall et al.'s meta-analysis as one of the selected studies.

  • Taira study is cited as a different reference

    Minor

    The text attributes the survey to Taira et al. but cites reference 18, which lists Buetow rather than Taira.

2 of 2

Cites

Flagged first, then by citations

3 of the 76 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Proceedings of the Conference of WHO 50th Anniversary Congress, 1998.

Cited by

Sorted by citations

Related

Authors
Willems, S., De Maesschalck, S., Deveugele, M., Derese, A., & De Maeseneer, J.
Affiliations
Ghent University (BE)
Corresponding author
Willems, S.
ORCID
Venue
Patient Education and Counseling
Publisher
Elsevier BV
Published
2005-02
Volume
56
Issue
2
Pages
139-146
ISSN
0738-3991 (ISSN-L)
DOI
10.1016/j.pec.2004.02.011
OpenAlex
W2099705687
Semantic Scholar
b99c83e93e48b48734376ebad8b31e9afd3c95f6
Cited by
582
References
76
Citations by year
2026: 15 · 2025: 19 · 2024: 36 · 2023: 26 · 2022: 33 · 2021: 34 · 2020: 34 · 2019: 44 · 2018: 42 · 2017: 31 · 2016: 40 · 2015: 27 · 2014: 32 · 2013: 29 · 2012: 28
FWCI
15.73
Type
journal article
Language
en
Open access
Licence
Locations
  • Patient Education and Counseling (publishedVersion)
  • PubMed (publishedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Health Professions › General Health Professions › Interpreting and Communication in Healthcare
  • Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
Keywords
socioeconomic status, physician-patient communication, social class, patient participation, information giving, patient empowerment, health disparities
MeSH terms
Affect, Attitude of Health Personnel, Communication, Cooperative Behavior, Emotions, Humans, Health Knowledge, Attitudes, Practice, Models, Psychological, Nonverbal Communication, Patient Education as Topic, Patient Participation, Physician-Patient Relations, Power, Psychological, Research Design, Social Class, Socioeconomic Factors, Verbal Behavior, Patient-Centered Care, Needs Assessment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-14.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-14.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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