This article presents an integrative perspective on the role that doctor-patient communication and cultural competency training play in health care disparities. Communication between minority patients and physicians is characterized by doctors' biased expectations, patients' perceptions of discrimination, linguistic asymmetry, and self-fulfilling prophecy spirals. Cultural competency training, which has been put forth as a remedy, is itself a complex construct, and methodological variations in cultural competency research make it difficult to reach simple conclusions about its effects. The authors review and synthesize the cross-disciplinary literature in these areas. They propose several directions for research, emphasizing that new studies can lay the groundwork for more trusting verbal communication between doctors and minority patients.

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This study analyzed New Zealand listener attitudes toward a New Zealand English speaker and a Standard American English speaker. The speakers altered levels of pitch variation and rate in their delivery of standard content messages. On balance, the impact of the paralinguistic behaviors was greater than that of accent.