process to increase truthfulness in doctor–patient interactions. Palmeira and Sterne suggest that physicians acknowledge their lack of knowledge, and discuss the amount of detail they wish to discuss to avoid deception. Physician bias Physicians have a tendency of overestimating their communication skills, as well as the amount of information they provide their patients. Extensive research conducted on 700 orthopedic surgeons and 807 patients, for instance, found that 75% of the surgeons perceived they satisfactorily communicated with their patients, whereas only 21% of the patients were actually satisfied with their communication. Physicians also show a high likelihood of underestimating their patients' information needs and desires, especially for patients who were not college educated or from economically disadvantaged backgrounds. There is pervasive evidence that patients' personal attributes such as age, sex, and socioeconomic status may influence how informative physicians are with their patients. Patients who are better educated and from upper or upper middle-class positions generally receive higher quality and quantity of information from physicians than do those toward the other end of the social spectrum, although both sides have an equal desire for information. Race, ethnicity and language has consistently proven to have a significant impact on how physicians perceive and interact with patients. According to a study of 618 medical encounters between mainly Caucasian physicians and Caucasian and African American patients, physicians perceived African Americans to be less intelligent and educated, less likely to be interested in an active lifestyle, and more likely to have substance abuse problems than Caucasians. A study of patients of color showed that having a white physician led to increased experience of microaggressions. Studies in Los Angeles emergency departments have found that Hispanic males and African Americans were less than half as likely to receive pain medication than Caucasians, despite physicians' estimates that patients were experiencing an equivalent level of pain. Another study showed that ethnic-minority groups of varying races reported lower-quality healthcare experiences than non-Hispanic Whites, specifically in treatment decision involvement and information received regarding medications. Other studies show that physicians exhibited substantially less rapport building and empathetic behavior with both Black and Hispanic patients than Caucasians, despite the absence of language barriers. Medical mistrust Mistrust of physicians or the healthcare system in general falls under the umbrella of medical mistrust. Medical mistrust negatively impacts the doctor–patient relationship, as a patient who has little faith in their physician is less likey to listen to