How Healthcare Bias Affects Patient-Provider Relationships

Patient and clinician biases and judgements can have a considerable impact on patient care, between how patients access care to patient-provider relationships, according to a recent WebMD survey.

The survey of over 1,000 patients and 1,100 providers showed that both parties face some sort of bias during the care encounter. For patients, biases about providers can have sway over treatment access decisions.

Twenty-nine percent of patients said they would avoid a certain provider based on personal characteristics, such as age, race, or gender. Women are more likely than men to say they prefer visiting a primary care provider who is the same gender, with 28 percent and 12 percent saying so, respectively.

Other provider characteristics cropped up as potential influencers for treatment access, including provider sexual orientation (11 percent), ethnicity (8 percent), religion (7 percent), political views (6 percent), and race (5 percent).

Patients also reported facing some sort of clinician bias, the survey revealed. Of the 90 percent of patients who have visited a healthcare professional in the past five years, 11 percent said they experience some sort of bias from their clinicians.

Over half of patients (58 percent) did not take any action in response to a biased remark, the survey showed. Twenty-six percent of patients responded by changing their primary care physician, and 15 percent confronted their provider about the matter. Thirteen percent of respondents have plans to change their provider in the future because of biased remarks and actions.

Patients are also turning to social media and clinician review websites to report their experiences with an allegedly biased clinician. Eleven percent of patients have left a negative online review after receiving a perceived offensive remark, and 7 percent have filed a formal complaint with the hospital or practice.

In contrast, 10 percent of clinicians reported that they have received a formal complaint from a patient.

Clinicians are not immune to bias in the healthcare setting, the survey revealed. A separate questionnaire completed by over 1,000 clinicians across the country showed that 59 percent of clinicians have experienced bias due to their physical appearances.

Forty-seven percent of providers said patients had requested another doctor because of biased opinions, the survey showed.

Ethnic minority clinicians are more likely to hear biased remarks than white doctors, with nearly 70 percent of black and Asian doctors reporting such.

There were also differences in experience for female and male doctors, the survey showed. Sixty-five percent of female clinicians face discrimination, compared to 55 percent of males.

Thirty-six percent of female clinicians heard negative comments about their age, a problem that was especially pressing for clinicians under age 34. Fifteen percent of female clinicians heard negative remarks about their weight.

In contrast, males heard more negative remarks about their ethnicity (24 percent) and age (23 percent). Males also saw religious bias at a higher rate than women, at 15 percent versus 8 percent, respectively.

Of all clinician respondents, nurses reported higher levels of patient bias than clinicians. Specifically, nurses were more likely to hear negative comments about their weight than other clinicians.

This culture of bias and judgement puts a considerable strain on patient-provider relationships, which are essential to a positive patient experience, said officials from WebMD and Medscape.

"When either a patient or a physician brings prejudice into the health care setting, it can strain the doctor-patient relationship, even if the treatment is not impacted," said WebMD & Medscape Senior Medical Director Arefa Cassoobhoy, MD, MPH. "Patients may be surprised to know that, according to the survey, not only do health care professionals notice bias, but they may document it in their chart."

The issue of clinician and patient bias and the strain it has on patient-provider relationships has recently come to the forefront in healthcare. In August 2017, Connecticut College research Joan Chrisler, PhD, explored how clinician bias about patient weight impacts their relationships and care quality.

Chrisler specifically looked at how clinician “fat shaming” was ineffective for driving patient motivation, and instead had adverse effects on the patient experience.

“Disrespectful treatment and medical fat shaming, in an attempt to motivate people to change their behavior, is stressful and can cause patients to delay health care seeking or avoid interacting with providers,” Chrisler said during a presentation at the 125th Annual Convention of the American Psychological Association.

“Implicit attitudes might be experienced by patients as microaggressions — for example, a provider’s apparent reluctance to touch a fat patient, or a headshake, wince or ‘tsk’ while noting the patient’s weight in the chart,” Chrisler continued. “Microaggressions are stressful over time and can contribute to the felt experience of stigmatization.”

Doctor biases can affect more than the patient-provider relationship. When a patient is overweight, a doctor may be more inclined to attribute health concerns to weight instead of underlying, unrelated medical issues.

Healthcare providers are not solely to blame for stigma in medicine – as the WebMD survey revealed, both patients and provider succumb to this behavior. However, it is up to providers to address these issues to work toward solutions to improve patient-provider relationships and patient outcomes.