Delving Below the Surface
Understanding How Race and Ethnicity Influence Relationships in Health Care
Lisa A. Cooper, MD, MPH,
Mary Catherine Beach, MD, MPH,
Rachel L. Johnson, MD, PhD,
Thomas S. Inui, MD, ScM
Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins University, Baltimore, MD, USA;
Department of Medicine,
Johns Hopkins University School of Medicine, Baltimore, MD, USA;
Bloomberg School of Public Health, Baltimore, MD, USA;
Department of Epidemiology, Johns Hopkins University Bloomberg School of
Public Health, Baltimore, MD, USA;
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA;
Regenstrief Institute, Indiana University Medical Center, Indianapolis, IN, USA.
There is increasing evidence that racial and ethnic mi-
nority patients receive lower quality interpersonal care
than white patients. Therapeutic relationships consti-
tute the interpersonal milieu in which patients are di-
agnosed, given treatment recommendations, and
referred for tests, procedures, or care by consultants
in the health care system. This paper provides a review
and perspective on the literature that explores the role
of relationships and social interactions across racial
and ethnic differences in health care. First, we examine
the social and historical context for examining differ-
ences in interpersonal treatment in health care along
racial and ethnic lines. Second, we discuss selected
studies that examine how race and ethnicity influence
clinician-patient relationships. While less is known
about how race and ethnicity influence clinician-com-
munity, clinician-clinician, and clinician-self relation-
ships, we briefly examine the potential roles of these
relationships in overcoming disparities in health care.
Finally, we suggest directions for future research on
racial and ethnic health care disparities that uses a re-
race; ethnicity; relationships; patient-
physician communication; disparities.
J GEN INTERN MED 2006; 21:S21–27.
ebster’s Dictionary defines ‘‘relationship’’ as ‘‘the state
of being .
. . connected through mutual interests or in-
Therapeutic relationships are the central inter-
personal milieu in which patients are diagnosed, given
treatment recommendations, and referred for appropriate
tests, procedures, or care by consultants in the health care
system. Yet, in health services research, relatively few studies
focus on the role of interpersonal relations and social interac-
tions in explaining racial and ethnic disparities in health.