The DOI matches its Crossref record; 73 of the 76 references it cites were found in a registry or an index; 4 of the 51 sources its claims cite were checked for support.
Socio-economic status of the patient and doctor–patient communication: does it make a difference?
Open accessAbstract
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.
Overview
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.
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Cites
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Verification
Claims the paper makes
4 of 51 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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)”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 1. Introduction
What the sources say
- Not matchedcites [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.
- Partly supportedcites [2] Lynch, 2001, Income inequality, the psychosocial environment, and health: comparisons of wealthy nations, Lancet sourceExperimental — accuracy not yet measured
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)
- Partly supportedcites [3] Turrell, 2001, Socio-economic inequalities in all-cause and specific-cause mortality in Australia: 1985–1987 and 1995–1997, Int J Epidemiol sourceExperimental — accuracy not yet measured
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)
- Not checked — no full text of the sourcecites [4] Mackenbach, 1994, A prospective cohort study investigating the explanation of socio-economic inequalities in health in The Netherlands, Soc Sci Med source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Not matched
Every source the paper cites for this claim was checked and supports it.
In the paper
“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).”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 3.2 Patient-centredness
What the sources say
- Supportedcites [34] McKinstry, 2000, Do patients wish to be involved in decision making in the consultation? A cross-sectional survey with video vignettes, BMJ source
The Results table reports the quoted odds ratios and 95% confidence intervals for social classes I and V. The Results and Abstract identify social class as an independent predictor and state that patients in higher social classes were more likely to prefer shared consultations. The class V estimate is not, by itself, a significant difference from the class III reference group. (LLM, conf=0.93)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Supported
In the paper
“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.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 4.1 Conclusions
What the sources say
- Not checked — no full text of the sourcecites [26] Street, 1992, Communicative styles and adaptations in physician–parent consultations, Soc Sci Med source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Doctors behave differently during consultations with patients from lower social classes.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 4.1 Conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“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.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 3.1.1 Verbal behaviour: instrumental behaviour
What the sources say
- Not checked — no full text of the sourcecites [28] Fiscella, 2002, Does patient educational level affect office visits to family physicians, J Natl Med Ass
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“The studies of Street et al. (supra) concluded that doctors provided more comments of reassurance, support and empathy to parents who were more affectively expressive (more specificly who expressed more negative affect).”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 3.1.2 Verbal behaviour: affective behaviour
What the sources say
- Not checked — no full text of the sourcecites [25] Street, 1991, Information giving in medical consultations: the influence of patients communicative styles and personal characteristics, Soc Sci Med source
- Not checked — no full text of the sourcecites [26] Street, 1992, Communicative styles and adaptations in physician–parent consultations, Soc Sci Med source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“No differences were found in the level of nonverbal communication towards patients of different educational backgrounds.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 3.1.3 Non-verbal behaviour
What the sources say
- Not checked — no full text of the sourcecites [31] Street, 1988, Patients characteristics affecting physician–patient nonverbal communication, Hum Commun Res source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIn the paper
“This study revealed a positive relationship between patient's social class (measured by income, education or other, non-specified social class indices) and information giving.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 3.1.1 Verbal behaviour: instrumental behaviour
What the sources say
- Not checked — no full text of the sourcecites [24] Hall, 1988, Meta-analysis of correlates of provider behavior in medical encounters, Med Care source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“In this perspective better communication (e.g. more question asking by the physician and by the patient, more information giving, shared decision making, more affective behaviour, …) seems to have a positive influence.(19,21)”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 1. Introduction
What the sources say
- Not checked — no full text of the sourcecites [19] Stewart, 1995, Effective physician–patient communication and health outcomes: a review, Can Med Ass J
- Not checked — no full text of the sourcecites [21] Kaplan, 1989, Assessing the effects of physician–patient interactions on the outcome of chronic disease, Med Care source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“In an observational study, Street et al. conclude that the physicians' information giving was positively influenced by features of the patient's communicative style such as question-asking, affective expressiveness and opinion-giving.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 3.1.1 Verbal behaviour: instrumental behaviour
What the sources say
- Not checked — no full text of the sourcecites [25] Street, 1991, Information giving in medical consultations: the influence of patients communicative styles and personal characteristics, Soc Sci Med source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- Probably not a substantial claim. 20
- It may state two separate claims as one. 15
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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)”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 1. Introduction
What the sources say
- Not checked — no full text of the sourcecites [5] Power, 1997, Origins of health inequalities in a national population sample, Lancet source
- Not checked — no full text of the sourcecites [6] Benzeval M, Judge K, Whitehead M. Tackling inequalities in health. London: King’s Fund; 1995.
- Partly supportedcites [7] Van de Mheen, 1998, Does childhood socioeconomic status influence adult health through behavioural factors?, Int J Epidemiol sourceExperimental — accuracy not yet measured
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)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“More educated patients communicate more actively (they ask more questions, are more opinionated) and show more affective expressiveness, eliciting more information from their physician.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 4.1 Conclusions
What the sources say
- Not checked — no full text of the sourcecites [25] Street, 1991, Information giving in medical consultations: the influence of patients communicative styles and personal characteristics, Soc Sci Med source
- Not checked — no full text of the sourcecites [26] Street, 1992, Communicative styles and adaptations in physician–parent consultations, Soc Sci Med source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 2. Methodology
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Articles determining SES by other variables than education, income or occupation (e.g.race, gender, health literacy) were excluded.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 2. Methodology
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“After exclusion, 12 articles were used to compare results.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 2. Methodology
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“MEDLINE and PsycINFO (1965PsycINFO ( -2002) ) were searched, using the following keywords:”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 2. Methodology
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Explanations for these inequalities in health are often explored but remain largely unclear.(4, 5)”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 1. Introduction
What the sources say
- Not checked — no full text of the sourcecites [4] Mackenbach, 1994, A prospective cohort study investigating the explanation of socio-economic inequalities in health in The Netherlands, Soc Sci Med source
- Not checked — no full text of the sourcecites [5] Power, 1997, Origins of health inequalities in a national population sample, Lancet source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“The important determinants for compliance are mainly more information giving, more positive talk and empathy and an increased participatory style.(13,17,18,20)”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 1. Introduction
What the sources say
- Not matchedcites [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.
- Not checked — no full text of the sourcecites [17] Squier, 1990, A model of empathic understanding and adherence to treatment regimens in practicioner–patient relationships, Soc Sci Med source
- Not checked — no full text of the sourcecites [18] Buetow, 1995, What do general practicioners and their patients want from general practice and are they receiving it?, Soc Sci Med source
- Not checked — no full text of the sourcecites [20] Lassen, 1991, Connections between the quality of consultations and patient compliance in general practice, Fam Pract source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Articles that were not original research articles, opinion articles and reviews were excluded.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 2. Methodology
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“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).”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 3.1.1 Verbal behaviour: instrumental behaviour
What the sources say
- Not checked — no full text of the sourcecites [26] Street, 1992, Communicative styles and adaptations in physician–parent consultations, Soc Sci Med source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“We considered several communication assessment approaches to cluster these variables.(22,23) Communicative behaviour can be categorised following the axis verbal/non-verbal behaviour.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 3. Results
What the sources say
- Not checked — no full text of the sourcecites [22] Ong, 1995, Doctor–patient communication: a review of the literature, Soc Sci Med source
- Not matchedcites [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.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Concerning patients at risk, physicians tended to discuss diet and exercise more with high income patients and smoking more with low income patients.(18)”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 3.1.1 Verbal behaviour: instrumental behaviour
What the sources say
- Not checked — no full text of the sourcecites [18] Buetow, 1995, What do general practicioners and their patients want from general practice and are they receiving it?, Soc Sci Med source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Less time was spent on patient's questions, assessing their health knowledge, negotiating and counselling, and less screening tests were provided to them.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 3.1.1 Verbal behaviour: instrumental behaviour
What the sources say
- Not checked — no full text of the sourcecites [28] Fiscella, 2002, Does patient educational level affect office visits to family physicians, J Natl Med Ass
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The comparison of the results of the selected studies was difficult, given the great variation in communication variables that had been tested.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 3. Results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“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)”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 1. Introduction
What the sources say
- Not matchedcites [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.
- Not matchedcites [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.
- Not checked — no full text of the sourcecites [15] Bensing, 1991, Doctor–patient communication and the quality of care, Soc Sci Med source
- Not checked — no full text of the sourcecites [16] Buller, 1987, Physicians’ communication style and patient satisfaction, J Health Soc Behav. source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We were able to categorise most of the used communicative variables following the axis verbal/non-verbal behaviour.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > Additional information
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The variables used in these classifications are not always comparable, making the creation of a clear overview difficult.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > Additional information
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 4.2 Limitations of the study
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In the selected articles many different communication classification systems were used to describe the communicative behaviour of the physician.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > Additional information
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The determinants of communication that did not fit into the categories of this axis, were related to patient centredness.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > Additional information
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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)”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 4.1 Conclusions
What the sources say
- Not checked — no full text of the sourcecites [25] Street, 1991, Information giving in medical consultations: the influence of patients communicative styles and personal characteristics, Soc Sci Med source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“An important limitation the researchers were confronted with when writing this review, is the limited number of studies on this specific topic.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 4.2 Limitations of the study
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > Additional information
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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)”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 3.2 Patient-centredness
What the sources say
- Not checked — no full text of the sourcecites [33] Kaplan, 1995, Patient and visit characteristics related to physician’s participatory decision making style, Med Care source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Even though physicians often ground their behaviour on these perceptions, this is not always in accordance with reality.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 4.1 Conclusions
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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)”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > 4.1 Conclusions
What the sources say
- Not checked — no full text of the sourcecites [25] Street, 1991, Information giving in medical consultations: the influence of patients communicative styles and personal characteristics, Soc Sci Med source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > Additional information
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Income is another possible parameter for social class as it creates differences in access to scarce material goods.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > Additional information
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Socio-economic status of the patient and doctor-patient communication: does it make a difference? > Additional information
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
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.”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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
MinorThe methods say reviews were excluded, yet the results discuss Hall et al.'s meta-analysis as one of the selected studies.
“Articles that were not original research articles, opinion articles and reviews were excluded.”
“In a meta-analysis, Hall et al. explored the correlation between physicians' communicative behaviour towards patients and the patient's outcome variables by reviewing 55 articles on 41 studies carried out between 1967 and 1986.”
Taira study is cited as a different reference
MinorThe text attributes the survey to Taira et al. but cites reference 18, which lists Buetow rather than Taira.
“In a patient completed mail survey among 6549 Massachusetts state employees by Taira et al., it was investigated whether the patients' income level had an influence on the physicians' discussion of health risk behaviours.Concerning patients at risk, physicians tended to discuss diet and exercise more with high income patients and smoking more with low income patients.(18)”
“18. Buetow S. What do general practicioners and their patients want from general practice and are they receiving it? Soc Sci Med 1995;40:213-221.”
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BackgroundUnderstanding the Relationship Between Education and Health
Zimmerman, E., & Woolf, S. H. (2014) · NAM Perspectives · doi:10.31478/201406a · Cited by 187
“In a review of the impact of patient socioeconomic status on patient-physician communication, Willems et al (2005) concluded that communication is influenced in part by patients' communicative ability and style, which depend largely on education and other personal attributes.”
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Poverty Increases Type 2 Diabetes Incidence and Inequality of Care Despite Universal Health Coverage
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“Less educated people encounter barriers due to communication (Willems et al., 2005) that they do not usually face when they speak with a GP.”
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“Yet adequately responding to these needs is often challenging for front-line healthcare providers (HCPs), specifically family physicians and primary care teams [20-23].”
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“Patients from high socioeconomic backgrounds made more attempts at active participation (Willems et al, 2005).”
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“Studies conducted in Western countries have shown that patients with higher levels of education tend to expect a partnership style of communication, whereas patients with lower educational levels tend to elicit a more paternalistic style (Murray et al. 2007; Willem et al. 2005).”
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“A systematic review of studies exploring the relationship between patient socio-economic status and doctor–patient communication found that poor patients were less involved in the decision-making process, asked fewer questions and had difficulty understanding the medical information provided by the physician (Willems…”
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“Disparities on the provider’s side could also exist where the lower SES population or specific populations receives different attention from the provider (Willems et al. 2005).”
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“When patients living in poverty access health services, they are more likely to have shorter consultation times than their wealthier peers [18], and are less likely to be involved in treatment decisions [ 19 ].”
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“A systematic review indicated that higher SES is associated repeatedly with increased overall physician-patient communication and provision of information.(26,27-29) Independent of patient behavior, differences in physicians’ engagement with patients have been related directly to patients’ levels of education.”
BackgroundSocioeconomic Status and Use of Outpatient Medical Care: The Case of Germany
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Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists
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Relational barriers to depression help-seeking in primary care
Kravitz, R. L., Paterniti, D. A., Epstein, R. M., Rochlen, A. B., Bell, R. A., Cipri, C. S., y García, E. F., Feldman, M. D., & Duberstein, P. R. (2010) · Patient Education and Counseling · doi:10.1016/j.pec.2010.05.007 · Cited by 78
Schieber, A.-C., Delpierre, C., Lepage, B., Afrité, A., Pascal, J., Cases, C., Lombrail, P., Lang, T., Kelly‐Irving, M., & for the INTERMEDE group (2014) · Family Practice · doi:10.1093/fampra/cmu057 · Cited by 72
“more question-asking, more information giving, shared decisionmaking and more empathic behaviour) seems to have a positive influence on the consultation, and represents an important determinant of accessibility in health care (7,12,13).”
BackgroundRietjens, J. A. C., Deschepper, R., Pasman, R., & Deliëns, L. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2011.12.046 · Cited by 72
Paul-Savoie, É., Bourgault, P., Potvin, S., Gosselin, É., & Lafrenaye, S. (2018) · Pain Research and Management · doi:10.1155/2018/6375713 · Cited by 72
Reported skin cancer screening of US adult workers
LeBlanc, W. G., Vidal, L., Kirsner, R. S., Lee, D. J., Caban-Martinez, A. J., McCollister, K. E., Arheart, K. L., Chung‐Bridges, K., Christ, S. L., Clark, J. D., et al. (2008) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2008.03.013 · Cited by 71
Putman, K. D., Wit, L. D., Schoonacker, M., Baert, I., Beyens, H., Brinkmann, N., Dejaeger, E. W., Meyer, A.-M. D., Weerdt, W. D., Feys, H., et al. (2006) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2006.094607 · Cited by 71
“interpersonal processes were defined as the social–psychological aspects of the patient–physician interaction. Communication is one of the dimensions in this interaction. General clarity, elicitation of and responsiveness to the patient’s problems and expectations, and explanations of progress and prognosis are descri…”
BackgroundSocioeconomic Status and the Course and Consequences of Chronic Pain
Bonathan, C., Hearn, L., & Williams, A. C. D. C. (2013) · Pain Management · doi:10.2217/pmt.13.18 · Cited by 69
Amelung, D., Whitaker, K. L., Lennard, D., Ogden, M., Sheringham, J., Zhou, Y., Walter, F. M., Singh, H., Vincent, C. A., & Black, G. B. (2019) · BMJ Quality & Safety · doi:10.1136/bmjqs-2019-009485 · Cited by 71
Deschepper, R., Bernheim, J., Stichele, R. V., den Block, L. V., Michiels, E., Kelen, G. V. D., Mortier, F., & Deliëns, L. (2008) · Patient Education and Counseling · doi:10.1016/j.pec.2007.11.015 · Cited by 66
Caiata-Zufferey, M., & Schulz, P. J. (2012) · Health Communication · doi:10.1080/10410236.2011.636478 · Cited by 67
“For example, after we noticed that physicians appraised several characteristics of the patient in order to decide how to behave, the article of Willems et al. (2005) helped us to interpret these data by suggesting the importance of patients’ education and, finally, by suggesting the category of…”
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Manfredi, C., Kaiser, K., Matthews, A. K., & Johnson, T. P. (2010) · Journal of Health Communication · doi:10.1080/10810731003686598 · Cited by 65
Webster, F., Rice, K., Katz, J. D., Bhattacharyya, O. K., Dale, C., & Upshur, R. E. G. (2019) · PLoS ONE · doi:10.1371/journal.pone.0215148 · Cited by 64
Placebo effects and racial and ethnic health disparities: an unjust and underexplored connection
Friesen, P., & Blease, C. R. (2018) · Journal of Medical Ethics · doi:10.1136/medethics-2018-104811 · Cited by 63
Enhancing parent–provider communication in ambulatory pediatric practice
Hart, C. N., Drotar, D., Gori, A., & Lewin, L. O. (2005) · Patient Education and Counseling · doi:10.1016/j.pec.2005.08.007 · Cited by 62
“Furthermore, recent data suggests that patients from lower social classes receive less positive socioemotional communication from their providers (due to both patients’ communication styles and doctors’ misperceptions) [19], thus highlighting the need for interventions targeted at such populations.”
BackgroundClaramita, M., van Dalen, J., & van der Vleuten, C. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2011.02.002 · Cited by 56
Loignon, C., Allison, P., Landry, A., Richard, L., Brodeur, J., & Bedos, C. (2010) · Journal of dentistry research · doi:10.1177/0022034510370822 · Cited by 44
“Communication skills are especially important when there is significant social distance between professionals and patients (Willems et al., 2005; Malat, 2006).”
BackgroundVitality, mental health, and satisfaction with information after breast cancer
Griggs, J. J., Sorbero, M. E. S., Mallinger, J. B., Quinn, M., Waterman, M., Brooks, B., Yirinec, B., & Shields, C. G. (2006) · Patient Education and Counseling · doi:10.1016/j.pec.2006.10.008 · Cited by 60
“There is some suggestion that patients of lower socioeconomic status (SES) seek less information than those of higher SES [2,37], but such apparent differences in preference for information may actually reflect differences in the quality of physician– patient communication according to socioeconomic status [47,48] and…”
BackgroundEmergency presentation and socioeconomic status in colon cancer
Gunnarsson, H., Ekholm, A., & Olsson, L. (2013) · European Journal of Surgical Oncology · doi:10.1016/j.ejso.2013.04.004 · Cited by 59
Choi, Y., Dodd, V. J. N., Watson, J., Tomar, S. L., Logan, H. L., & Edwards, H. (2008) · Patient Education and Counseling · doi:10.1016/j.pec.2007.11.011 · Cited by 59
Coats, H., Downey, L., Sharma, R. K., Curtis, J. R., & Engelberg, R. A. (2018) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2018.07.005 · Cited by 61
The Stanford Prison Experiment
Onishi, S. L., & Hebert, R. S. (2014) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909114552126 · Cited by 57
Clinical Inertia in Depression Treatment
Henke, R. M., Zaslavsky, A. M., McGuire, T. G., Ayanian, J. Z., & Rubenstein, L. V. (2009) · Medical Care · doi:10.1097/mlr.0b013e31819a5da0 · Cited by 58
The Patient‐Centered Medical Home and Patient Experience
Martsolf, G. R., Alexander, J. A., Shi, Y., Casalino, L. P., Rittenhouse, D. R., Scanlon, D. P., & Shortell, S. M. (2012) · Health Services Research · doi:10.1111/j.1475-6773.2012.01429.x · Cited by 54
“2009) and because they are also likely correlated with the patient care experience (The Commonwealth Fund 2002; Willems et al. 2005; Wilshire et al. 2009).”
BackgroundWhat is a good medical decision? A research agenda guided by perspectives from multiple stakeholders
Hamilton, J. G., Lillie, S. E., Alden, D. L., Scherer, L. D., Oser, M. L., Rini, C. K., Tanaka, M., Baleix, J., Brewster, M., Lee, S. J. C., et al. (2016) · Journal of Behavioral Medicine · doi:10.1007/s10865-016-9785-z · Cited by 53
“The multiple sources of imbalance between patients and providers in a given health decision context—imbalances in decision experience, power, influence, emotions—may ultimately interfere with patients’ ability to achieve a good decision process and/or outcome (Willems et al., 2005).”
BackgroundSocioeconomic deprivation increases the risk of disability in multiple sclerosis patients
Calocer, F., Dejardin, O., Kwiatkowski, A., Bourre, B., Vermersch, P., Hautecœur, P., Launoy, G. D., & Defer, G. L. (2020) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2020.101930 · Cited by 53
Molenaar, J. M., Korstjens, I., Hendrix, M. J. C., Vries, R. G. D., & Nieuwenhuijze, M. J. (2018) · Birth · doi:10.1111/birt.12379 · Cited by 52
Köberich, S., Feuchtinger, J., & Farin‐Glattacker, E. (2016) · BMC Nursing · doi:10.1186/s12912-016-0137-7 · Cited by 50
Fors, A., Gyllensten, H., Swedberg, K. B., & Ekman, I. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.07.060 · Cited by 50
Haggerty, J. L., Burge, F., Beaulieu, M., Pineault, R., Beaulieu, C., Lévesque, J., Santor, D. A., Gass, D. A., & Lawson, B. J. (2011) · Healthcare policy · doi:10.12927/hcpol.2011.22691 · Cited by 49
“…in evaluations is important, because low literacy is an independent health risk (smith and Haggerty 2003), and subjects will be more dependent than high-literacy subjects on their doctors’ actions and advice (Bostick et al. 1994; Fiscella et al. 2002; Breitkopf et al. 2004; Willems et al. 2005).”
BackgroundModes, M. E., Engelberg, R. A., Downey, L., Nielsen, E. L., Curtis, J. R., & Kross, E. K. (2018) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2018.10.507 · Cited by 50
Schoeb, V., & Bürge, E. (2011) · Physiotherapy Research International · doi:10.1002/pri.516 · Cited by 48
Effect of Service Barriers on Health Status of Aging South Asian Immigrants in Calgary, Canada
Lai, D. W. L., & Surood, S. (2013) · Health & Social Work · doi:10.1093/hsw/hls065 · Cited by 48
Cooper, J. A., Moriarty, F., Ryan, C. A., Smith, S. M., Bennett, K., Fahey, T. P., Wallace, E., Cahir, C., Williams, D. J., Teeling, M., et al. (2016) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-015-2003-z · Cited by 46
Aelbrecht, K., Rimondini, M., Bensing, J., Moretti, F., Willems, S., Mazzi, M., Fletcher, I., & Deveugele, M. (2015) · Advances in Health Sciences Education · doi:10.1007/s10459-014-9569-6 · Cited by 45
“Willems et al. (2004) described how these patients often find themselves in a vicious circle, where their more passive behaviour in a consultation elicits a lessinvolved behaviour from the doctor.”
BackgroundSelf-citationPhysician communication behaviors from the perspective of adult HIV patients in Kenya
Wachira, J., Middlestadt, S. E., Reece, M., Peng, C. J., & Braitstein, P. K. A. (2014) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzu004 · Cited by 45
Compassionate care: Enhancing physician–patient communication and education in dermatology
Nguyen, T. V., Hong, J., & Prose, N. S. (2013) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2012.10.059 · Cited by 46
Educational Inequalities in Health Behaviors at Midlife
Clouston, S., Richards, M., Cadar, D., & Hofer, S. M. (2015) · Journal of Health and Social Behavior · doi:10.1177/0022146515594188 · Cited by 48
“Similarly, education may help to improve the ability to interface effectively with health care professionals and, thus, one’s ability to encode health information and comply with recommendations about health behaviors outside the medical system (Willems et al. 2005).”
BackgroundExploring health-seeking behaviour of disadvantaged populations in rural Bangladesh
Ahmed, S. M. (2005) · Figshare · Cited by 45
Job, C., Adenipekun, B., Cleves, A., Gill, P., & Samuriwo, R. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-081723 · Cited by 44
“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.”
BackgroundReasons to Amplify the Role of Parental Permission in Pediatric Treatment
Navin, M. C., & Wasserman, J. A. (2017) · The American Journal of Bioethics · doi:10.1080/15265161.2017.1378752 · Cited by 43
Missinne, S., Neels, K., & Bracke, P. (2014) · Sociology of Health & Illness · doi:10.1111/1467-9566.12169 · Cited by 44
“Sociological explanations for these divergences are scarce (Waitzkin, 1985; Willems et al., 2005), but important insights could be derived from the observation that patients in a higher socio-economic position secure more information from doctors, through effective expressiveness and assertiveness…”
BackgroundWener, M. E., Schönwetter, D. J., & Mazurat, N. M. (2011) · Journal of Dental Education · doi:10.1002/j.0022-0337.2011.75.12.tb05212.x · Cited by 45
Fors, A., Swedberg, K. B., Ulin, K., Wolf, A., & Ekman, I. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.08.069 · Cited by 44
“This reasoning is strengthened by the more prominent effects of the gPCC intervention observed in patients with low education, who often are disadvantaged by a more directive and less participatory consultation approach [32, 33].”
BackgroundAwareness of medical ethics among undergraduates in a West Bengal medical college
Chatterjee, B., & Sarkar, J. (2012) · Indian Journal of Medical Ethics · doi:10.20529/ijme.2012.029 · Cited by 44
Compassionate care: Enhancing physician–patient communication and education in dermatology
Hong, J., Nguyen, T. V., & Prose, N. S. (2013) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2012.10.060 · Cited by 43
Acceptability, trust and equity
Gilson, L. (2007) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544460.008 · Cited by 45
Metadata
- Authors
- Willems, S., De Maesschalck, S., Deveugele, M., Derese, A., & De Maeseneer, J.
- Affiliations
- Ghent University (BE)
- Corresponding author
- Willems, S.
- Venue
- Patient Education and Counseling
- Publisher
- Elsevier BV
- Published
- 2005-02
- Volume
- 56
- Issue
- 2
- Pages
- 139-146
- ISSN
- 0738-3991 (ISSN-L)
- 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
- green
- biblio.ugent.be
- 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
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