A study suggests an approach to promote more equitable interpersonal treatment

Coaching patients to voice concerns about their health care and advocate for themselves can counter doctors’ racial bias so that it doesn’t lead to inferior experiences for black patients, a University of Michigan-led analysis found.

The researchers showed that doctors’ implicit biases, which often favor whites over blacks, manifest in the way they interact with their patients, but only if patients act normally when communicating with their doctors. (For example, most patients don’t pressure their doctors when they give them an unclear answer.)

If patients were trained to be “activated”, even if -; asking direct but polite questions from a list they brought with them and asking for clarification if they didn’t understand a concept -; the effects of bias disappeared.

“Many of us believe that nothing can be done about disparities and inequities, especially interpersonal ones,” said Jennifer Griggs, MD, MPH, professor of hematology and oncology at the University of Michigan Medical School and of management. and health policy in the UM School of Public Health, who served as lead author of this article. “What we found was that activating patients to ask questions, to interrupt when necessary to make sure their needs are met, overrode patterns of care and biases clinicians may have about expected patient behaviors.”

Previous research has revealed that most non-black health care providers have an inherent, typically unconscious, preference for white patients over blacks that can manifest in poorer care, including spending less time with black patients and communicate in ways that are not patient. centered.

This is one of the first studies to identify a strategy that not only reduces the racial bias of physicians, but also creates more equitable interactions between physicians and patients.

The quality of care you receive from your doctor may be affected. This finding is encouraging and may be an antidote to the hopelessness we often feel when addressing disparities in care.”


Jennifer Griggs, lead author of the study and professor of Hematology and Oncology at the University of Michigan Medical School

Over several years, Griggs and his team of researchers recruited black and white actors to serve as studio patients at three different sites across the country.

The actors were trained to play the same character: male, divorced, diagnosed with lung cancer that had spread to the bone and had been treated with radiation and opioids. The only difference was the color of the actors’ skin and how they were trained to interact with their doctors.

Of particular importance: training “activated” actors to be assertive and persistent in advocating for their needs without appearing aggressive or suspicious.

“We were very careful not to overactivate anyone because we didn’t want to push back the doctors,” Griggs said. “What motivates doctors is to be trusted. So if patients ask questions in a way that implies they don’t trust the doctor, then the doctor can get defensive and start thinking about himself, not in the patient.”

“Minority groups have long histories of oppression and reasons not to trust the medical system due to breaches of trust and dignity,” he added. “The training was a way to help patients get what they need without having to work hard in order to make the doctor feel comfortable.”

After 181 visits to 96 doctors, the actors completed various surveys that rated measures ranging from their satisfaction with their overall care and perceptions of doctors’ empathy to nonverbal communication cues like eye contact.

Independent coders also reviewed recordings of visits to independently assess clinicians’ communication skills and whether discussions on topics such as pain management were patient-centered.

The results were clear: activation significantly reduced the impact of bias on doctor-patient interactions. Given the evidence that implicit biases are difficult to change, the idea that patients might have some control over the quality of their care is encouraging, says Griggs.

But, as the document points out, “the responsibility for receiving equitable care should not rest with patients.”

“Rather, it is the responsibility of physicians and medical institutions to provide high-quality, impartial care to all patients,” the authors write. “Patients from minority groups bear a disproportionate burden from discrimination within the health care system. Asking them to change the way they act may increase the burden on the very people subjected to discrimination. Therefore, for both practical and ethical reasons , academics and clinicians should also focus on developing and implementing health equity interventions that focus on changing clinician attitudes and behavior as well as policies in health care systems.”

For now, though, Griggs recommends that doctors try to be more mindful of whether they’re addressing the questions their patients are asking and giving them the opportunity to set the schedule for their visits.

“We will most likely do this less often with people where there is more social distance, whether it’s age, gender, race, ethnicity, or sexual and gender minority status,” Griggs said. “You have to think less about yourself and more about meeting the needs of your patients.”

Other authors include Izzy Gainsburg of the University of Michigan and Harvard University; Veronica Derricks of UM and Indiana University-Purdue University in Indianapolis; Cleveland Shields of Purdue University; and Kevin Fischella, Ronald Epstein, and Veronica Yu of the University of Rochester.

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Magazine reference:

Gainsburg, I. et al. (2022) Patient activation reduces the effects of implicit bias in doctor-patient interactions. Proceedings of the National Academy of Sciences. doi.org/10.1073/pnas.2203915119.

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