Impact of Perceived Discrimination in Healthcare on Patient-Provider Communication

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 [beta = -0.41, 95% confidence interval (CI) = -0.73 to -0.09] and providers (beta = -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 (beta = -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.