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The social gradient in doctor-patient communication

Evelyn Verlinde12*, Nele De Laender1, Stéphanie De Maesschalck1, Myriam Deveugele1 and Sara Willems1

Author Affiliations

1 Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium

2 Verlinde Evelyn, Department of Family Medicine and Primary Health Care, Ghent University, UZ-1 K3, De Pintelaan 185, B-9000 Ghent, Belgium

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International Journal for Equity in Health 2012, 11:12  doi:10.1186/1475-9276-11-12

Published: 12 March 2012



In recent years, the importance of social differences in the physician-patient relationship has frequently been the subject of research. A 2002 review synthesised the evidence on this topic. Considering the increasing importance of social inequalities in health care, an actualization of this review seemed appropriate.


A systematic search of literature published between 1965 and 2011 on the social gradient in doctor-patient communication. In this review social class was determined by patient's income, education or occupation.


Twenty original research papers and meta-analyses were included. Social differences in doctor-patient communication were described according to the following classification: verbal behaviour including instrumental and affective behaviour, non-verbal behaviour and patient-centred behaviour.


This review indicates that the literature on the social gradient in doctor-patient communication that was published in the last decade, addresses new issues and themes. Firstly, most of the found studies emphasize the importance of the reciprocity of communication.

Secondly, there seems to be a growing interest in patient's perception of doctor-patient communication.

Practice implications

By increasing the doctors' awareness of the communicative differences and by empowering patients to express concerns and preferences, a more effective communication could be established.

Communication; Physician-patient relations; Social class