Physician Racial Bias and Word Use during Racially Discordant Medical Interactions

Abstract

Physician racial bias can negatively affect Black patients’ reactions to racially discordant medical interactions, suggesting that racial bias is manifested in physicians’ communication with their Black patients. However, little is known about how physician racial bias actually influences their communication during these interactions. This study investigated how non-Black physicians’ racial bias is related to their word use during medical interactions with Black patients. One hundred and seventeen video-recorded racially discordant medical interactions from a larger study were transcribed and analyzed using Linguistic Inquiry and Word Count (LIWC) software. Physicians with higher levels of implicit racial bias used first-person plural pronouns and anxiety-related words more frequently than physicians with lower levels of implicit bias. There was also a trend for physicians with higher levels of explicit racial bias to use first-person singular pronouns more frequently than physicians with lower levels of explicit bias. These findings suggest that non-Black physicians with higher levels of implicit racial bias may tend to use more words that reflect social dominance (i.e., first-person plural pronouns) and anxiety when interacting with Black patients.

The effects of racial attitudes on affect and engagement in racially discordant medical interactions between non-Black physicians and Black patients

“…For example, physicians’ general implicit racial bias predicts how much physicians verbally dominate a medical interaction: Physicians with higher levels of general implicit racial bias talk more (Cooper et al, 2012; Hagiwara, Penner, Gonzalez, Eggly, et al, 2013) and faster (Cooper et al, 2012) than physicians with lower levels of implicit bias. Also, Hagiwara, Slatcher, Eggly, and Penner (in press) found a positive association between physician implicit bias and the number of anxiety-related words used in racially discordant medical interactions. Importantly, there is evidence that Black patients are sensitive to their physician’s level of general implicit racial bias and react more negatively to physicians with higher levels of implicit bias than to those with lower levels of implicit bias.…”

Addressing microaggressions in racially charged patient-provider interactions: a pilot randomized trial

“…Many of these biases expressed in provider-patient interactions are seen as operating on implicit levels, in that the biases that influence behavior are activated automatically and outside the provider's awareness, are difficult for the provider to control, and occur in contrast to the provider's explicitly espoused anti-racist attitudes and identity [5,6]. For example, White providers who score higher on measures of implicit bias, but not explicit bias, speak faster, dominate conversations, have shorter visits [7,8], display fewer positive nonverbal cues [9] and less warmth [10], and use more first-person plural pronouns and anxietyrelated words [11,12] when interacting with Black patients. In turn, both Black patients and independent observers provide lower ratings of visit satisfaction and patient-centered care for White providers [7,10,13,14].…”

Interaction Between Race and Gender and Effect on Implicit Racial Bias Against Blacks

“…[46][47][48][49][50][51][52] The race-IAT is shown as an effective experimental tool to assess implicit racial bias. [29][30][31][32]51,52 The IAT follows a standard protocol described by Nosek et al 49 Participants categorize pictures or words representing the four categories -White, Black, good, bad -in two different sorting sets. Stimuli that represent the above four categories are presented one at a time in the center of a computer monitor.…”

“…[26][27][28] Implicit bias also influences Blacks' opportunity for employment, education, and health care. [29][30][31][32] There is growing evidence suggesting that exposure and vulnerability to racial bias is a function of the intersection of race and gender, with Black men having higher exposure and vulnerability to discrimination than Black women. 17,22,[33][34][35] In addition to exposure, 17 the intersection of race and gender also alters harmful effects of discrimination.…”

“…42 While explicit bias results in mental and behavioral health problems, 23,24,43 there is a need to study factors that shape social patterning of implicit bias as well, which influences a wide range of domains such as interaction and quality of health care. [29][30][31][32] The current study was conducted to test race by gender differences in implicit bias against Blacks. Similar to the literature on the intersection of race and gender on explicit bias, 40,44 and in line with the subordinate male target hypothesis, 40 the highest level of implicit bias was expected in White men.…”