Impact of Perceived Discrimination in Healthcare on Patient-Provider Communication

Abstract

Background The impact of patients’ perceptions of discrimination in health care on patient-provider interactions is unknown. Objective Examine association of past perceived discrimination with subsequent patient-provider communication. Research Design Observational cross-sectional study. Subjects African American (AA; N=100) and white (N=253) patients treated for osteoarthritis by orthopedic surgeons (N=63) in two Veterans Affairs facilities. Measures Patients were surveyed about past experiences with racism and classism in healthcare settings before a clinic visit. Visits were audio-recorded and coded for instrumental and affective communication content (biomedical exchange, psychosocial exchange, rapport-building, patient engagement/activation) and nonverbal affective tone. After the encounter, patients rated visit informativeness, provider warmth/respectfulness, and ease of communicating with the provider. Regression models stratified by patient race assessed the associations of racism and classism with communication outcomes. Results Perceived racism and classism were reported by more AA patients than by white patients (racism: 70% vs. 26%; classism: 73% vs. 53%). High levels of perceived racism among AA patients was associated with less positive nonverbal affect among patients (Beta=−0.41, 95% CI=−0.73, −0.09) and providers (Beta=−0.34, 95% CI=−0.66, −0.01) and with low patient ratings of provider warmth/respectfulness (OR=0.19, 95% CI=0.05,0.72) and ease of communication (OR =0.22, 95% CI=0.07,0.67). Any perceived racism among white patients was associated with less psychosocial communication (Beta=−4.18, 95% CI=−7.68, −0.68), and with low patient ratings of visit informativeness (OR=0.40, 95% CI=0.23,0.71) and ease of communication (OR=0.43, 95% CI=0.20,0.89). Perceived classism yielded similar results. Conclusions Perceptions of past racism and classism in healthcare settings may negatively impact the affective tone of subsequent patient-provider communication.

Perceived Discrimination and Reported Trust and Satisfaction in African Americans: The Jackson Heart Study

“…1 Perceived discrimination strongly influences patient response to health care providers [2][3] and may account for the greater mistrust, dissatisfaction, and negative perceptions of providers reported by AAs compared with Caucasians. [4][5] Researchers have reported links between trust, satisfaction and perceptions of discrimination from providers. [6][7][8][9] Trust in health care providers is the belief that the provider will act for the benefit of the patient.…”

Childhood Racism Experiences and Postpartum Depressive Symptoms in African American Mothers

“…Studies in nationally representative samples show that a majority of African Americans frequently experience racism, which negatively influences employment prospects (Bertrand & Mullainathan, 2004;Wallace, Mendola, Liu, & Grantz, 2015), housing opportunities (Emerson, Yancey, & Chai, 2001), physical health (Richman, Bennett, Pek, Siegler, & Williams, 2007;Ryan, Gee, & Laflamme, 2006), and healthcare experiences (Hausmann et al, 2011). Racism may also affect individuals at important life stages.…”

Dehumanization as an Ethical Issue in the Health Services Sector

“…They dehumanized black people by equating them with monkeys, linked them to more crimes than they linked the white people, and considered using violence (including the death penalty) against black people as just, while they did not consider so against white people (Goff, Eberhardt, Williams, & Jackson, 2008). The mostly implicit discriminative attitudes of health personnel toward patients may dehumanize them, and when perceived, this may damage the health personnel-patient relationship (Hausmann et al, 2011).…”