Impact of perceived discrimination in healthcare on patient-provider communication

Med Care. 2011 Jul;49(7):626-33. doi: 10.1097/MLR.0b013e318215d93c.


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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Black or African American / psychology*
  • Communication*
  • Cross-Sectional Studies
  • Female
  • Healthcare Disparities / ethnology*
  • Humans
  • Male
  • Middle Aged
  • Orthopedics / statistics & numerical data
  • Osteoarthritis, Hip / therapy
  • Osteoarthritis, Knee / therapy
  • Perception
  • Prejudice*
  • Professional-Patient Relations*
  • Quality of Life
  • Socioeconomic Factors
  • United States
  • United States Department of Veterans Affairs / statistics & numerical data
  • White People / psychology*