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Racism in Healthcare

A doctor is escorting his patient into the waiting room after a cursory visit; he refrains

from initiating friendly conversation, and keeps his clipboard to his chest in a defensive manner.

When they reach the waiting room, he holds open the door, averts his eyes and gives her a curt

nod as he sends her off. The doctor’s next patient, however, is welcomed with a genial smile and

his clipboard is now at his side as he guides her to the designated room with a gentle hand on her

back. What is the reasoning behind these apparent differences in the treatment of his patients?

This information will help: the initial patient was of a minority background, and the patient that

was catered to was not. By using nonverbal communication, the doctor has displayed his

preference of one ethnicity over another. ​Body language and gestures have contributed to

inimical health care systems and adverse relationships between healthcare providers and

their patients.

Racial imbalance in healthcare has continuously transpired, but over time, it has evolved

into a robust monster. In the 1900’s racism was embraced, as opposed to the 21st century where

it is deemed sickening, nonetheless, this does not condense the escalation of racial bigotry over

the years. The inhumane need for racial division was so urgent that the people’s lives became

frivolous. Sick and wounded bodies of African Americans were dropped off at hospitals like

packages without proper attention. Patients, however, were not the only ones suffering from the

ruthless racism. Physicians, surgeons, and other professional healthcare providers were

repudiated and their titles challenged, even if they graduated from the most prestigious of

schools. The results of a survey asking patients to rate their relationship with their doctor makes

it evident that very little has changed in the timespan of 100 years (see fig. 1). Due to the

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standstill of progress of racism, there is only one obvious difference in racism in the workplace:

insinuation.

Racism in the 21st century, particularly in the workplace, can be characterized by its

subtlety. Patients and doctors now use body language and gestures to disguise their intentions.

This prejudiced behavior, or any behavior for that matter, is first established in the waiting room.

For this reason, receptionists, as well as patients, are held responsible for the mood that is set

upon arrival. In an interview with Beth L. Carlson, M.D., she stated “​This is a topic that is

discussed often in health care facilities. As important as the physician/patient relationship, is the

initial encounter when entering a healthcare facility. The front office staff's mission needs to be

to create a welcoming, comforting and helpful environment for the patient.” ​Simple gestures

such as gentle head nods, small waves, and other nonverbal forms of communication can result

in an atmosphere of affability. In the event that this does not occur, one might overlook the

absence of a welcoming environment but, by examining patient-provider communication, the

pernicious racism that lurks in the doctor's office is evinced.

Simple body gestures made by doctors when they first come in contact with a patient can

be interpreted as heedless and nonchalant. A study conducted in 2015 by Amber Barnato, an

associate professor at the University of Pittsburgh School of Medicine, explored the idea that

certain body gestures communicate apathetic tones between healthcare providers and their

patients. “Something as simple as a physician staying near the door and holding a binder in front

of them could be perceived by the patient and family as defensive or disengaged

(Hydzik-Pittsburgh),” Barnato states after analyzing the results of the study. These cautious

gestures are generally directed towards minorities more often than majority races, and result in

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misunderstandings in patient-provider communication. A poll was taken in which multiple

ethnicities rated the quality of their patient-doctor communication; minorities often chose a lower

rating than majority races (see fig. 1). This miscommunication may be caused by unintentional

attitudes expressed by one individual to another.

Figure 1.​ Patient’s ratings of their relationship with their doctor. Data collected October

15, 2017.

Implicit bias, also referred to as unconscious bias, is a term used to describe the

involuntary stereotypes and attitudes that accumulate overtime and, consequently, result in

misinterpreted intentions. Without verbal communication, there is little clarity as to one’s

attitude about a subject. Barnato stated, “Poor nonverbal communication-something the

physician may not even be aware that he or she is doing- could explain why many...patients

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perceive discrimination in the healthcare setting (Hydzik-Pittsburgh).” Nonchalant tones form as

a result of both conscious and unconscious bias, but when they formed as a result of unconscious

bias, the issue tends to be overlooked. Both communicators are most likely oblivious to the

attitudes traveling between them, so it frequently goes unnoticed. Eventually one of the

communicators will recognize the apathetic body gestures and tones, and a feeling of

insignificance will be induced. “​Apathy gives the patient a sense of mistrust,” Dr. Carlson states,

“They do not feel they are being listened to, nor that the physician cares about the problems they

are having. Apathy has no place in the medical field.”​ For this reason, implicit bias is the most

destructive factor to the doctor-patient relationship.

The emotional state of an individual is not the only component that is imperiled by

unconscious bias, their physical state suffers as well. One of the major effects of implicit bias in

healthcare is patients not being provided the proper medication that is needed. This factor alone

can provoke fatal cases of sickness and disease. Elizabeth N. Chapman, Anna Kaatz, and Molly

Carnes, who work in the medical department at the University of Wisconsin-Madison state,

“Two studies found that Black patients seen in emergency departments receive less analgesia

than White patients. Hispanic patients in one study were seven times less likely to receive

opioids in the emergency room than non-Hispanic patients with similar injuries...These findings

were duplicated in Black patients (Chapman, Kaatz, Cranes).” Implicit bias also influences

patients to take sporadic trips to the doctor, even if their health condition demands cyclical visits.

Doctors often fail to avert this inequitable treatment despite being trained to do so. In their

defense, training oneself’s mind be cognizant to a process that ultimately is uncontrollable and

unremarked is impossible.

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In conclusion, nonverbal communication is essential in creating healthy relationships

between healthcare providers and their patients. Without decipherable body language, there is a

greater chance of misperceptions, which can be fatal to both the human connection. This is

demonstrated in the graph by a pronounced difference in the ratings of patient-doctor

communication given by the majority, as opposed to the minorities. Once one of the interlocutors

senses bias in the atmosphere, the situation should be addressed; otherwise healthcare systems,

as well as individual’s health, will continue to suffer. Assuming the bias taking place is implicit,

the individual conveying this attitude will often be clueless as to how their actions are being

perceived, which is why communication is crucial. The exigency for being comfortable in an

environment in which one’s health is involved cannot be stressed enough. After all, who would

risk their life on account of misinterpreted actions?

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Citations

Carlson, Beth. Dr. Personal Interview. 8 November 2017

Hydzik-Pittsburgh, Allison. “Do doctors deliver racism with body language?” ​Futurity​, 4

Jan. 2016, ​www.futurity.org/doctors-racism-body-language-1083782/​. Accessed 16 October

2017

Chapman, Elizabeth N., Anna Kaatz, and Molly Carnes. “Physicians and Implicit Bias: How

Doctors May Unwittingly Perpetuate Health Care Disparities.” ​Journal of General Internal

Medicine​ 28.11 (2013): 1504–1510. ​PMC​. Web. 14 October, 2017.

Blair, Irene V, John F Steiner, and Edward P Havranek. “Unconscious (Implicit) Bias and Health

Disparities: Where Do We Go from Here?” ​The Permanente Journal​ 15.2 (2011): 71–78. Print.