Impact of perceived discrimination in healthcare on patient-provider communication

Leslie R.M. Hausmann, Michael J. Hannon, Denise M. Kresevic, Barbara H. Hanusa, C. Kent Kwoh, Said A. Ibrahim

Research output: Contribution to journalArticle

66 Scopus citations

Abstract

Background: The impact of patients' perceptions of discrimination in healthcare on patient-provider interactions is unknown. Objective: To examine association of past perceived discrimination with subsequent patient-provider communication. Research Design: Observational cross-sectional study. Subjects: African-American (N=100) and white (N=253) patients treated for osteoarthritis by orthopedic surgeons (N=63) in 2 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, and 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 African-American patients than by white patients (racism: 70% vs. 26% and classism: 73% vs. 53%). High levels of perceived racism among African-American patients was associated with less positive nonverbal affect among patients [β=-0.41, 95% confidence interval (CI)=-0.73 to -0.09] and providers (β=-0.34, 95% CI=-0.66 to -0.01) and with low patient ratings of provider warmth/respectfulness [odds ratio (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 (β=-4.18, 95% CI=-7.68 to -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.

Original languageEnglish (US)
Pages (from-to)626-633
Number of pages8
JournalMedical Care
Volume49
Issue number7
DOIs
StatePublished - Jul 1 2011
Externally publishedYes

Keywords

  • Social discrimination
  • Veterans health
  • communication
  • minority health
  • physician patient relations

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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    Hausmann, L. R. M., Hannon, M. J., Kresevic, D. M., Hanusa, B. H., Kwoh, C. K., & Ibrahim, S. A. (2011). Impact of perceived discrimination in healthcare on patient-provider communication. Medical Care, 49(7), 626-633. https://doi.org/10.1097/MLR.0b013e318215d93c