Journal of General Internal Medicine

, Volume 27, Issue 5, pp 576–581 | Cite as

Non-Verbal Communication Between Primary Care Physicians and Older Patients: How Does Race Matter?

  • Irena StepanikovaEmail author
  • Qian Zhang
  • Darryl Wieland
  • G. Paul Eleazer
  • Thomas Stewart
Original Research



Non-verbal communication is an important aspect of the diagnostic and therapeutic process, especially with older patients. It is unknown how non-verbal communication varies with physician and patient race.


To examine the joint influence of physician race and patient race on non-verbal communication displayed by primary care physicians during medical interviews with patients 65 years or older.


Video-recordings of visits of 209 patients 65 years old or older to 30 primary care physicians at three clinics located in the Midwest and Southwest.


Duration of physicians’ open body position, eye contact, smile, and non-task touch, coded using an adaption of the Nonverbal Communication in Doctor–Elderly Patient Transactions form.


African American physicians with African American patients used more open body position, smile, and touch, compared to the average across other dyads (adjusted mean difference for open body position = 16.55, p < 0.001; smile = 2.35, p = 0.048; touch = 1.33, p < 0.001). African American physicians with white patients spent less time in open body position compared to the average across other dyads, but they also used more smile and eye gaze (adjusted mean difference for open body position = 27.25, p < 0.001; smile = 3.16, p = 0.005; eye gaze = 17.05, p < 0.001). There were no differences between white physicians’ behavior toward African American vs. white patients.


Race plays a role in physicians’ non-verbal communication with older patients. Its influence is best understood when physician race and patient race are considered jointly.


communication race aging 





This study was supported by University of South Carolina Research Opportunity Program, “Racial and Ethnic Disparities in Non-Verbal Communication Between Physicians and Elderly Patients: A Pilot Study." ($47,557)

Prior presentations


Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Irena Stepanikova
    • 1
    • 2
    Email author
  • Qian Zhang
    • 3
  • Darryl Wieland
    • 4
  • G. Paul Eleazer
    • 5
  • Thomas Stewart
    • 6
  1. 1.Department of SociologyUSCColumbiaUSA
  2. 2.Institute for Research in the Social SciencesStanford UniversityPalo AltoUSA
  3. 3.Department of SociologyUSCColumbiaUSA
  4. 4.Division of Geriatrics ServicesPalmetto Richland HospitalColumbiaUSA
  5. 5.Division of GeriatricsUSC School of MedicineColumbiaUSA
  6. 6.Division of GeriatricsUSC School of MedicineColumbiaUSA

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