Clinicians may have conscious or unconscious biases when it comes to the race and ethnicity of patients. These racial attitudes can have a negative impact on the patient-doctor relationship, including communication problems and how patients experience their care, suggests a new study. Researchers examined visits between 40 primary care clinicians and 269 patients from urban community-based practices.
They used cognitive tests of unconscious bias among the clinicians and analyzed audiotapes of the visits to reveal communication patterns. They found that bias and stereotyping were associated with markers of poor communication during patient visits and resulted in low ratings of care by patients in a post-visit survey. The findings were particularly evident among black patients, who appeared most affected by these attitudes and behaviors.
The patients were participating in two randomized trials investigating patient-provider communication for patients with hypertension and depression. Clinicians demonstrating general race bias displayed more verbal dominance and had poorer ratings of interpersonal care among black patients. Black patients also ranked these clinicians lower in their respect for them, liking their provider, having confidence in them, and recommending the provider to friends and family. White patients perceived clinicians with higher levels of general race bias differently. They were more likely to perceive respect from these providers and believed they were liked by them.
Results were somewhat different for clinicians who demonstrated implicit race and compliance stereotyping. In the case of black patients, race and compliance stereotyping resulted in longer visits, a slower pace of speech, less patient-centered dialogue, and poorer ratings of interpersonal care. White patients experienced shorter visits, more rapid pace of speech, more patient-centered dialogue, and less verbal dominance by clinicians. Blacks and whites perceived clinicians with race and compliance stereotyping more negatively.
The researchers speculated that due to greater exposure to discrimination in society, blacks may be particularly sensitive to verbal and non-verbal cues, such as smiling, social comments made, and speech factors. The study was supported in part by the Agency for Healthcare Research and Quality (HS13645).
See "The associations of clinicians' implicit attitudes about race with medical visit communication and patient ratings of interpersonal care," by Lisa A. Cooper, M.D., M.P.H., Debra L. Roter, Dr.P.H., Kathryn A. Carson, Sc.M., and others in the May 2012 American Journal of Public Health 102(5), pp. 979-987.