Maybe They Had a Bad Day: How Marginalized Patients React To Bias In Healthcare and Struggle to Speak Out

Abstract

BackgroundMarginalized people, including Black, Indigenous, People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender, Queer, and sexually diverse and gender diverse people (LGBTQ+) are subject to implicit bias during healthcare interactions which negatively impacts patient-provider communication and the quality of care. In this qualitative study, we collected 25 personal stories of unfair treatment from patients from marginalized populations. We report on participants’ reactions to implicit bias and the longer-term consequences and harms of experiencing that bias. MethodsWe recruited racially- and gender-diverse participants through institutional networks, social media, and community champions. Inclusion criteria were: (1) to be BIPOC and/or LGBTQ+, (2) be 18 years of age or older, and (3) reside in the United States of America. Participants completed an hour-long remote semi-structured interview. In these interviews, we asked participants to tell us their stories about experiencing discrimination when visiting a healthcare provider. Interview data was summarized with qualitative thematic analysis. FindingsFrom our thematic analysis, we found four distinct ways patients responded to implicit bias (Reactions to Bias) and a myriad of longer-term consequences and reactions from having to adapt to bias (The Aftermath). Our findings explore in detail how patients from marginalized communities choose to respond to bias and surfaced key institutional barriers to speaking out against and reporting bias. InterpretationOur themes describe how individuals navigate Implicit bias in healthcare, how that bias can cause longer-term harms for marginalized people, and the barriers to reporting that bias. More research is needed to explore the prevalence of this bias and make providers more aware of the effects of implicit bias on patients. FundingThis study was funded by the United States National Library of Medicine (NLMR01LM013301).