The social gradient in doctor-patient communication

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.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.In 1977 a commission under the lead of Sir Francis Black published the famous Black report, illustrating the existence of a social gradient in health in the UK. The publication of this report was the start of a new wave of research on social inequity [1]. Since then many studies have confirmed the gradient in health between social classes [2-4]. Health differences between social groups due to underlying social mechanisms such as differential access to care, social exclusion or poverty are a matter of major concern in today's public health research but in spite of marked health improvements of the overall population and efforts to overcome health inequalities, higher morbidity and mortality rates for the socio-economically disadvantaged are still found [5-8]. The causes for these inequalities in health are multiple and complex: a different distribution of power and resources among social classes, different levels of exposure to healt