Racial bias in healthcare is a systemic problem that has significant impacts on patient outcomes, damages the levels of communication that are only reached with a healthy doctor-patient relationship, and stigmatizes future interactions between non-white patients and white doctors. One manifestation of this bias is the preference for racially concordant doctors among patients from ethnic and racial minorities. Concordance, or matching between patients and doctors in terms of race or ethnicity, is believed to lead to better communication, understanding of cultural nuances, and trust between patients and their doctors. This essay will explore the reasons behind the preference for racially concordant doctors and what this concept poses for patients and the healthcare system. This will be achieved through analysis of secondary sources, including the oral histories of Lata Chatterjee, a former professor of Geography and Environmental Engineering who shares her childhood in India and explains the friction that came with dealing with the healthcare system as an immigrant of low socioeconomic status battling the costs of medical care, and Jacqui Laukaitis, a healthcare worker from South Chile who describes her experiences working in an Open Door clinic, highlighting the contrast between the treatment of white and colored patients and navigation of the healthcare system for non-white vs white patients, as well as calling for further advocacy of patients who get overlooked and mistreated because of race.
Reasons for Preference of Racially Concordant Doctors
The preference for racially concordant doctors is often linked to communication barriers. Patients from ethnic and racial minorities may face language barriers, lack of familiarity with medical terminology, and cultural differences that impede effective communication with doctors from different backgrounds. This barrier was especially present in Lata Chatterjee’s experience with healthcare due to her being an immigrant and someone of low socioeconomic status. She states that the entire experience feels like “not knowing what’s wrong with you and wanting to have the care that you know people have the knowledge for but you don’t deserve it because of who you are in the status system” (0:43:55.3-0:44:50.1). This led Lata to venture outside the pool of available doctors, and seek physicians that are closer to her in race, views, and other qualities. In fact, studies have shown that concordance between patients and doctors can significantly improve communication and lead to better health outcomes (Saha et al., 1714, 2011). Patients who see racially concordant doctors are more likely to report greater satisfaction with their care and more likely to adhere to their treatment plan (Laveist et al., 298, 2002).
In addition to communication barriers, trust is another important factor in the preference for racially concordant doctors. Patients from ethnic and racial minorities may have experienced discrimination and racism in their everyday lives, which can extend to a lack of trust in healthcare providers. This mistrust can be exacerbated when patients do not feel understood and validated and are often dismissed by doctors from different racial and ethnic backgrounds through the use of insensitive language that does not fully take into account these factors (Hagiwara et al., 3, 2013). Trust in healthcare providers is critical to building a strong patient-provider relationship, and racial concordance can improve trust and confidence in the healthcare system.
This preference is due to the level of cultural competency shown by non-white doctors, or those who either share such culture and race or have had experience treating individuals of different origins, and, therefore, different customs, lifestyles, and perceptions regarding disease (Metzl et al., 1, 2014). This was apparent when Lata recalled her mother’s experience with Western healthcare, where increased confidence in care was exhibited once her mother was able to choose to receive care in India from people who share her race and culture; her mother stated, with the support from the interviewer, “‘I can have the healthcare here I want. I won’t go back.’ She never came back. So, it was for healthcare she didn’t come back” (0:54: 11.7- 0:55:22.9). Cultural competency, or lack thereof, largely influences the types of relationships between patients and their physicians, with the ability to alter what resources and treatments are available to patients of color, how they are treated by medical staff, and their healing process.
The Impact of Racial Bias Leading to Racial Concordance
The preference for racially concordant physicians highlights the impact of racial bias in healthcare. Studies have shown that racial bias is pervasive in healthcare, leading to poorer health outcomes for patients from ethnic and racial minorities (Saha et al, 1714, 2011). This effect was exhibited when Jacqui Laukaitis recalls her time working at Open Door: “People have not really been treated correctly, as far as I’m concerned, because of their ethnicity. I’ve seen where the doctor just comes in and just kind of checks them out and goes out the door and doesn’t even say anything to them when there has been no interpreter. Because we’ll go in and we’ll say to the patient, ‘Didn’t they call an interpreter for when the doctor saw you?…’” (0:52:12.1- 0:53: 33.7). The answer was always no. Not only does this highlight a reason to elect for a racially concordant professional, but also brings attention to the lack of attention received because of racial, ethnic, and language barriers that add time to the ‘efficiency first’ outlook of many free/low-cost clinics (Adepoju, 665, 2015).
In addition to bias in treatment, racial bias also affects the diagnosis itself, which leads patients to seek racially concordant doctors in the first place. Studies have shown that people of color are more likely to be misdiagnosed with serious illnesses such as heart disease and cancer than white patients (Laveist et al., 303, 2002). This bias is linked to a lack of understanding of the nuances of disease presentation in different racial and ethnic groups, as well as implicit biases that lead to diagnostic errors. The misunderstanding and dismissal that trigger such a need for racially concordant doctors were explained by Jacqui when she recalled the relationships she built with patients on the basis that she, too, was a person of color. She stated, “We don’t know anybody’s situation. I mean, everybody’s situation’s so different from the next person, and for people to just judge people by, ‘Oh, they’re just illegals.’ They’re not just illegals; they’re human beings and they deserve to be treated with respect and dignity just like anybody else.” (1:06:35.3- 1:07:11.2). For Jacqui, this highlighted the systematic need for more physicians and healthcare providers to account for those patients left with white doctors due to a shortage of non-white doctors and have to fend for themselves, oftentimes rejecting treatment because of the lack of trust in white doctors. These disparities are linked to systemic inequalities in healthcare where resources are limited for those of color and misdiagnoses/mistreatment is prevalent.
Addressing Racial Bias in Healthcare
To address racial bias in healthcare, it is important to understand the root causes of this bias and work to address them at every level of the healthcare system. This includes education and training for healthcare providers to recognize and address their implicit biases (Hagiwara et al., 6, 2013). It also involves ensuring diversity in the healthcare workforce to increase racial and ethnic concordance between patients and providers.
Policies and practices should be implemented to address disparities in healthcare outcomes for racial and ethnic minorities (Metzl et al., 3, 2014). This includes expanding access to healthcare services, improving cultural competency, and developing bias training for healthcare providers that promote patient-centered care through the use of sensitive language and improvements to the way patients are addressed by their healthcare providers (in ways that are not patronizing), which play a large role in determining the doctor-patient relationship and transparency between the two parties (Hagiwara et al., 3, 2013). It also involves addressing social determinants of health, such as poverty, racism, and discrimination, which contribute to poor health outcomes for marginalized communities. Such factors did not weigh greatly on the health of white Americans, going unexamined and ending up dismissed in cases where the patient was a person of color.
An approach to addressing racial bias in healthcare is through patient empowerment. Patient-centered care models that prioritize patient input and preferences can help reduce the impact of bias in healthcare. This includes involving patients from different racial and ethnic backgrounds in the design of healthcare policies and practices, as well as in decision-making regarding their own healthcare.
Conclusion
The preference for racially concordant doctors among patients from ethnic and racial minorities highlights the impact of racial bias in healthcare. Communication barriers, trust issues, and lack of cultural understanding are all factors that contribute to the preference for racially concordant doctors. Attending to this preference is critical to improving healthcare outcomes for marginalized communities, and the biases were oftentimes successfully addressed once patients met with someone of their race, who understood how those factors affect the experience and treatment of disease and relayed their support (Metzl et al., 6, 2014).
Addressing biases in treatment and diagnosis begins with promoting diversity in the healthcare workforce and taking seriously the social determinants of health. The use of technology and patient empowerment where patients are validated rather than patronized can also play a critical role in reducing bias in healthcare. Ultimately, addressing racial bias in healthcare requires a comprehensive approach that involves all stakeholders in the healthcare system, from providers to policymakers to patients themselves.
References
Hagiwara, Nao, et al. “Physician Racial Bias and Word Use during Racially Discordant Medical Interactions.” Health Communication, vol. 32, no. 4, 2016, pp. 401–408., doi:10.1080/10410236.2016.1138389.
Jacqui Laukaitis interview Y-0108, 02 August 2019 in the Southern Oral History Program Collection (#4007), Wilson Library, University of North Carolina at Chapel Hill
Lata Chatterjee interview Y-0084, 11 October 2018 in the Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
LaVeist, Thomas A., and Amani Nuru-Jeter. “Is Doctor-Patient Race Concordance Associated with Greater Satisfaction with Care?” Journal of Health and Social Behavior, vol. 43, no. 3, 2002, pp. 296–306. JSTOR, https://doi.org/10.2307/3090205. Accessed 30 Apr. 2023.
Metzl, Jonathan M, and Helena Hansen. “Structural competency: theorizing a new medical engagement with stigma and inequality.” Social science & medicine (1982) vol. 103 (2014): 126-133. doi:10.1016/j.socscimed.2013.06.032
Omolola E. Adepoju, Michael A. Preston, and Gilbert Gonzales, 2015: Health Care Disparities in the Post–Affordable Care Act Era American Journal of Public Health 105, S665_S667, https://doi.org/10.2105/AJPH.2015.302611
Somnath Saha, Jose J. Arbelaez, and Lisa A. Cooper, 2011: Patient–Physician Relationships and Racial Disparities in the Quality of Health Care American Journal of Public Health 93, 1713_1719, https://doi.org/10.2105/AJPH.93.10.1713