Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits

By Debra L. Roter; Judith A. Hall | Go to book overview

4
The Influence of Physician Characteristics on Communication between the Doctor and the Patient

Who the doctor is--his or her profile in terms of sociodemographic background, culture, and personality, as well as the medical training experience-- has relevance for how patients are treated and the kind of medicine that will be practiced.

Some people are more likely to become doctors than others. The sociodemographic profile that has traditionally characterized the medical profession is disproportionately male, white, and upper-middle-class (Mechanic, 1978). Efforts to diversify medical school enrollment since the 1960s have been somewhat successful, but only in relative terms. The most dramatic change from the 1960s to the 1980s has been a sevenfold increase, from 5% to 37%, in women entering medical school ( Jonas & Etzel, 1988). Changes in other aspects of the demographic profile, however, have been more modest. Black enrollees in medical school make up about 5% of the total, with all other minorities adding another 5% ( Jonas & Etzel, 1988).

Less attention has been paid in recent years to changes in the middle-class profile of medical students. However, there is little to suggest that the strong bias toward enrollment of students from the higher socioeconomic classes has changed. As parental income increases, there is a consistent increase in the percentage of students who apply to medical school and those who are accepted ( Rosengren, 1980). Inasmuch as the debt burden continues to grow exponentially for medical students, from $19,697 in 1981 to an average of $33,499 in 1987 ( Tudor, 1988), and as federal assistance continues to decline, it is unlikely that there will be major changes in the class structure of medicine. Considering the economic ramifications of medical school atten-

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