Disparities in healthcare and health outcomes between whites and non-whites continue to plague the US healthcare system. A large literature suggests that people of color face obstacles at various points in the healthcare system. This article examines one such obstacle: whether patients of color experience microaggressions from physicians during primary care medical visits. A majority of microaggression studies are qualitative and retrospective in nature. In the current study, we use a prospective approach to broaden how microaggressions are measured, as well as understand differential treatment of racial minorities within healthcare. Using data derived from audio recordings of medical visits (n = 224), we utilize a quantitative measure to examine microaggressions in the medical encounter. We find that when race status differences are present between patient and physician, patients of color are more likely to experience microaggressions from their physician. The results suggest that medical encounters differ depending on characteristics of the parties involved. These differences may not only perpetuate the differential treatment of people of color but also contribute to health disparities for people of color.
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Bobo LD. Racism in Trump’s America: reflections on culture, sociology, and the 2016 US presidential election. Br J Sociol. 2017;68(S1):S85–S104.
Hall JM, Fields B. ‘It’s Killing Us!’ Narratives of Black adults about microaggression experiences and related health stress. Glob Qual Nurs Res. 2015;2:2333393615591569.
Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health? Annu Rev Sociol. 2015;41(1):311–30.
Smedley A, Smedley BD. Race in North America, fourth. Boulder: Westview Press; 2012.
Bobo L, Kluegel JR, Smith RA, "Laissez-Faire racism: the crystallization of a ‘kinder, gentler’ anti-Black ideology.,” Russell Sage Foundation, 1996. [Online]. Available: https://www.researchgate.net/publication/281453429_Laissez-faire_Racism_The_Crystallization_of_a_Kinder_Gentler_Antiblack_Ideology. Accessed 11/10/2019.
Bonilla-Silva E. Racism without racists: color-blind racism and the persistence of racial inequality in the United States, Fourth. Lanham: Rowman & Littlefield Publishers, Inc.; 2014.
Sue DW, et al. Racial microaggressions in everyday life: implications for clinical practice. Am Psychol. 2007;62(4):271–86.
Sue DW. Microaggressions and marginality. Hoboken: John Wiley & Sons, Inc.; 2010.
Nadal KL, Griffin KE, Wong Y, Hamit S, Rasmus M. The impact of racial microaggressions on mental health: counseling implications for clients of color. J Couns Dev. 2014;92(1):57–66.
Walls ML, Gonzalez J, Gladney T, Onello E. Unconscious biases: racial microaggressions in American Indian health care. J Am Board Fam Med. 2015;28(2):231–9.
Keith VM, Nguyen AW, Taylor RJ, Mouzon DM, Chatters LM. Microaggressions, discrimination, and phenotype among African Americans: a latent class analysis of the impact of skin tone and BMI. Sociol Inq. 2017;87(2):233–55.
Solorzano D, Ceja M, Yosso T. Critical race theory, racial microaggressions, and campus racial climate: the experiences of African American college students. J Negro Educ. 2000;69(1/2):60–73.
Sue DW, Capodilupo CM, Holder AMB. Racial microaggressions in the life experience of Black Americans. Prof Psychol Res Pract. 2008;39(3):329–36.
Nadal KL, Wong Y, Sriken J, Griffin K, Fujii-Doe W. Racial microaggressions and Asian Americans: an exploratory study on within-group differences and mental health. Asian Am J Psychol. 2015;6(2):136–44.
Grollman EA, Hagiwara N. ‘Discrimination’ versus ‘unfair treatment’: measuring differential treatment and its association with health. Sociol Inq. 2019;89(4):645–76.
Cruz D, Rodriguez Y, Mastropaolo C. Perceived microaggressions in health care: a measurement study. PLoS One. 2019;14(2):e0211620.
Rowe MP. Barriers to equality: the power of subtle discrimination to maintain unequal opportunity. Empl Responsib Rights J. 1990;3(2):153–63.
Pierce CM, Carew JV, Pierce-Gonzalez D, Wills D. An experiment in racism: TV commercials. Educ Urban Soc. 1977;10(1):61–87.
Nadal KL. That’s so gay! Microaggressions and the lesbian, gay, bisexual, and transgender community. Washington, DC: American Psychological Association; 2013.
Smith-Oka V. Microaggressions and the reproduction of social inequalities in medical encounters in Mexico. Soc Sci Med. 2015;143:9–16.
Sacks TK. Invisible visits: Black middle-class women in the American healthcare system: Oxford University Press; 2019.
Brondolo E, Rieppi R, Kelly KP, Gerin W. Perceived racism and blood pressure: a review of the literature and conceptual and methodological critique. Ann Behav Med. 2003;25(1):55–65.
Lukachko A, Hatzenbuehler ML, Keyes KM. Structural racism and myocardial infarction in the United States. Struct Stigma Popul Health. 2014;103:42–50.
Cobb RJ, Thomas CS, Laster Pirtle WN, Darity WA. Self-identified race, socially assigned skin tone, and adult physiological dysregulation: assessing multiple dimensions of ‘race’ in health disparities research. SSM - Popul Health. 2016;2:595–602.
Galli C. The ambivalent U.S. context of reception and the dichotomous legal consciousness of unaccompanied minors. Soc Probl. 2019;spz041.
Bourdieu P, Wacquant LJ. An invitation to reflexive sociology. Chicago: The University of Chicago Press; 1992.
Goold SD, Lipkin M Jr. The doctor-patient relationship. J Gen Intern Med. 1999;14(S1):S26–33.
Ha JF, Anat DS, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10:38–43.
Roter DL, Hall JA. Doctors talking with patients/patients talking with doctors, Second. Westport: Praeger Publishers; 2006.
Parsons T. The social system. Glencoe: The Free Press; 1951.
Peck BM, Conner S. Talking with me or talking at me? The impact of status characteristics on doctor-patient interaction. Sociol Perspect. 2011;54(4):547–67.
Heritage J, Maynard DW. Problems and prospects in the study of physician-patient interaction: 30 years of research. Annu Rev Sociol. 2006;32(1):351–74.
Street R. How clinician-patient communication contributes to health improvement: modeling pathways from talk to outcome. Patient Educ Couns. 2013;92(3):286–91.
Chandra S, Mohammadnezhad M, Ward P. Trust and communication in a doctor- patient relationship: a literature review. J Healthc Commun. 2018;03(03):1–6.
Bertakis KD, Franks P, Epstein RM. Patient-centered communication in primary care: physician and patient gender and gender concordance. J Women's Health. 2009;18(4):539–45.
Cooper LA, et al. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;102(5):979–87.
Peck BM, Denney M. Disparities in the conduct of the medical encounter: the effects of physician and patient race and gender. SAGE Open. 2012;2(3):1–14.
Ross PT, Lypson ML, Kumagai AK. Using illness narratives to explore African American perspectives of racial discrimination in health care. J Black Stud. 2012;43(5):520–44.
Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003.
House JS. Beyond Obamacare: life, death, and social policy. New York: Russell Sage Foundation; 2015.
Penner LA, Dovidio JF, Gonzalez R, Albrecht TL, Chapman R, Foster T, et al. The effects of oncologist implicit racial Bias in racially discordant oncology interactions. J Clin Oncol. 2016;34(24):2874–80.
Joseph B, Fisek H, Norman R, Morris Z Jr. Status characteristics and social interaction: an expectation-states approach. Santa Barbara: Greenwood Publishing Group; 1977.
Berger J, Cohen BP, Morris Z Jr. Status characteristics and social interaction. Am Sociol Rev. 1972;37(3):241–55.
Merton RK. The self-fulfilling prophecy. In: Merton R, editor. Social theory and social structure. New York: Simon & Schuster; 1968.
Berger J, Conner TL. Performance expectations and behavior in small groups: a revised formulation. In: Berger J, Conner TL, Fisek MH, editors. Expectation states theory: a theoretical research program. Cambridge: Winthrop; 1974.
Roter DL, Larson S. The Roter interaction analysis system (RIAS): utility and flexibility for analysis of medical interactions. Patient Educ Couns. 2002;46:243–51.
McCarthy DM, Buckley BA, Engel KG, Forth VE, Adams JG, Cameron KA. Understanding patient-provider conversations: what are we talking about? Acad Emerg Med. 2013;20(5):441–8.
Roter D, Hall JA. Doctor-patient communication: why and how communication contributes to the quality of medical care. In: Gellman MD, Turner JR, editors. Encyclopedia of behavioral medicine. New York: Springer New York; 2013. p. 622–7.
Marin CR, Gasparino RC, Puggina AC. The perception of territory and personal space invasion among hospitalized patients. PLOS One. 2018;13(6).
Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters. Med Care. 1988;26(7):657–75.
Hox JJ. Multilevel analysis. 2nd ed. New York: Routledge; 2010.
Hamilton B, Martin J, Osterman M, Rossen L. Vital statistics rapid release; no 7. Hyattsville: National Center for Health Statistics; 2019.
Verlinde E, De Laender N, De Maesschalck S, Deveugele M, Willems S. The social gradient in doctor-patient communication. Int J Equity Health. 2012;11:12.
Eliassen AH. Power relations and health care communication in older adulthood: educating recipients and providers. Gerontologist. 2016;56(6):990–6.
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Miller, L.R., Peck, B.M. A Prospective Examination of Racial Microaggressions in the Medical Encounter. J. Racial and Ethnic Health Disparities 7, 519–527 (2020). https://doi.org/10.1007/s40615-019-00680-y
- Provider-patient communication
- Medical encounter
- Health disparities