Skip to main content

A Prospective Examination of Racial Microaggressions in the Medical Encounter

Abstract

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.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    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.

    PubMed  Google Scholar 

  2. 2.

    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.

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health? Annu Rev Sociol. 2015;41(1):311–30.

    Google Scholar 

  4. 4.

    Smedley A, Smedley BD. Race in North America, fourth. Boulder: Westview Press; 2012.

    Google Scholar 

  5. 5.

    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.

  6. 6.

    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.

    Google Scholar 

  7. 7.

    Sue DW, et al. Racial microaggressions in everyday life: implications for clinical practice. Am Psychol. 2007;62(4):271–86.

    PubMed  Google Scholar 

  8. 8.

    Sue DW. Microaggressions and marginality. Hoboken: John Wiley & Sons, Inc.; 2010.

    Google Scholar 

  9. 9.

    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.

    Google Scholar 

  10. 10.

    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.

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    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.

    PubMed  PubMed Central  Google Scholar 

  12. 12.

    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.

    Google Scholar 

  13. 13.

    Sue DW, Capodilupo CM, Holder AMB. Racial microaggressions in the life experience of Black Americans. Prof Psychol Res Pract. 2008;39(3):329–36.

    Google Scholar 

  14. 14.

    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.

    Google Scholar 

  15. 15.

    Grollman EA, Hagiwara N. ‘Discrimination’ versus ‘unfair treatment’: measuring differential treatment and its association with health. Sociol Inq. 2019;89(4):645–76.

    Google Scholar 

  16. 16.

    Cruz D, Rodriguez Y, Mastropaolo C. Perceived microaggressions in health care: a measurement study. PLoS One. 2019;14(2):e0211620.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Rowe MP. Barriers to equality: the power of subtle discrimination to maintain unequal opportunity. Empl Responsib Rights J. 1990;3(2):153–63.

    Google Scholar 

  18. 18.

    Pierce CM, Carew JV, Pierce-Gonzalez D, Wills D. An experiment in racism: TV commercials. Educ Urban Soc. 1977;10(1):61–87.

    Google Scholar 

  19. 19.

    Nadal KL. That’s so gay! Microaggressions and the lesbian, gay, bisexual, and transgender community. Washington, DC: American Psychological Association; 2013.

    Google Scholar 

  20. 20.

    Smith-Oka V. Microaggressions and the reproduction of social inequalities in medical encounters in Mexico. Soc Sci Med. 2015;143:9–16.

    PubMed  Google Scholar 

  21. 21.

    Sacks TK. Invisible visits: Black middle-class women in the American healthcare system: Oxford University Press; 2019.

  22. 22.

    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.

    PubMed  Google Scholar 

  23. 23.

    Lukachko A, Hatzenbuehler ML, Keyes KM. Structural racism and myocardial infarction in the United States. Struct Stigma Popul Health. 2014;103:42–50.

    Google Scholar 

  24. 24.

    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.

    PubMed  PubMed Central  Google Scholar 

  25. 25.

    Galli C. The ambivalent U.S. context of reception and the dichotomous legal consciousness of unaccompanied minors. Soc Probl. 2019;spz041.

  26. 26.

    Bourdieu P, Wacquant LJ. An invitation to reflexive sociology. Chicago: The University of Chicago Press; 1992.

    Google Scholar 

  27. 27.

    Goold SD, Lipkin M Jr. The doctor-patient relationship. J Gen Intern Med. 1999;14(S1):S26–33.

    PubMed Central  Google Scholar 

  28. 28.

    Ha JF, Anat DS, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10:38–43.

    PubMed  PubMed Central  Google Scholar 

  29. 29.

    Roter DL, Hall JA. Doctors talking with patients/patients talking with doctors, Second. Westport: Praeger Publishers; 2006.

    Google Scholar 

  30. 30.

    Parsons T. The social system. Glencoe: The Free Press; 1951.

    Google Scholar 

  31. 31.

    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.

    Google Scholar 

  32. 32.

    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.

    Google Scholar 

  33. 33.

    Street R. How clinician-patient communication contributes to health improvement: modeling pathways from talk to outcome. Patient Educ Couns. 2013;92(3):286–91.

    PubMed  Google Scholar 

  34. 34.

    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.

    Google Scholar 

  35. 35.

    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.

    Google Scholar 

  36. 36.

    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.

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    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.

    Google Scholar 

  38. 38.

    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.

    Google Scholar 

  39. 39.

    Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003.

    Google Scholar 

  40. 40.

    House JS. Beyond Obamacare: life, death, and social policy. New York: Russell Sage Foundation; 2015.

    Google Scholar 

  41. 41.

    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.

    PubMed  PubMed Central  Google Scholar 

  42. 42.

    Joseph B, Fisek H, Norman R, Morris Z Jr. Status characteristics and social interaction: an expectation-states approach. Santa Barbara: Greenwood Publishing Group; 1977.

    Google Scholar 

  43. 43.

    Berger J, Cohen BP, Morris Z Jr. Status characteristics and social interaction. Am Sociol Rev. 1972;37(3):241–55.

    Google Scholar 

  44. 44.

    Merton RK. The self-fulfilling prophecy. In: Merton R, editor. Social theory and social structure. New York: Simon & Schuster; 1968.

    Google Scholar 

  45. 45.

    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.

    Google Scholar 

  46. 46.

    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.

    PubMed  Google Scholar 

  47. 47.

    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.

    PubMed  Google Scholar 

  48. 48.

    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.

    Google Scholar 

  49. 49.

    Marin CR, Gasparino RC, Puggina AC. The perception of territory and personal space invasion among hospitalized patients. PLOS One. 2018;13(6).

  50. 50.

    Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters. Med Care. 1988;26(7):657–75.

    CAS  PubMed  Google Scholar 

  51. 51.

    Hox JJ. Multilevel analysis. 2nd ed. New York: Routledge; 2010.

    Google Scholar 

  52. 52.

    Hamilton B, Martin J, Osterman M, Rossen L. Vital statistics rapid release; no 7. Hyattsville: National Center for Health Statistics; 2019.

    Google Scholar 

  53. 53.

    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.

    PubMed  PubMed Central  Google Scholar 

  54. 54.

    Eliassen AH. Power relations and health care communication in older adulthood: educating recipients and providers. Gerontologist. 2016;56(6):990–6.

    PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding authors

Correspondence to Leslie Riggle Miller or B. Mitchell Peck.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Microaggressions
  • Provider-patient communication
  • Medical encounter
  • Health disparities
  • Race