Physician Racial Bias and Word Use during Racially Discordant Medical Interactions

Nao Hagiwara, Richard B Slatcher, Susan Eggly, Louis A Penner, Nao Hagiwara, Richard B Slatcher, Susan Eggly, Louis A Penner

Abstract

Physician racial bias can negatively affect Black patients' reactions to racially discordant medical interactions, suggesting that racial bias is manifested in physicians' communication with their Black patients. However, little is known about how physician racial bias actually influences their communication during these interactions. This study investigated how non-Black physicians' racial bias is related to their word use during medical interactions with Black patients. One hundred and seventeen video-recorded racially discordant medical interactions from a larger study were transcribed and analyzed using Linguistic Inquiry and Word Count (LIWC) software. Physicians with higher levels of implicit racial bias used first-person plural pronouns and anxiety-related words more frequently than physicians with lower levels of implicit bias. There was also a trend for physicians with higher levels of explicit racial bias to use first-person singular pronouns more frequently than physicians with lower levels of explicit bias. These findings suggest that non-Black physicians with higher levels of implicit racial bias may tend to use more words that reflect social dominance (i.e., first-person plural pronouns) and anxiety when interacting with Black patients.

References

    1. Abe JAA. Positive emotions, emotional intelligence, and successful experiential learning. Personality & Individual Differences. 2011;51:817–822.
    1. Abe JAA. Words that predict outstanding performance. Journal of Research in Personality. 2009;43:528–531.
    1. Blair IV, Steiner JF, Fairclough DL, Hanratty R, Price DW, Hirsh HK, Havranek EP. Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Annals of Family Medicine. 2013;11:43–52.
    1. Brigham JC. College students’ racial attitudes. Journal of Applied Social Psychology. 1993;23:1933–1967.
    1. Cene CW, Roter D, Carson KA, Mille ER, 3rd, Cooper LA. The effect of patient race and blood pressure control on patient-physician communication. Journal of General Internal Medicine. 2009;24:1057–1064.
    1. Chen FM, Fryer GE, Phillips RL, Wilson E, Pathman DE. Patients’ beliefs about racism, preferences for physician race, and satisfaction with care. Annals of Family Medicine. 2005;3:138–143.
    1. Chung CK, Pennebaker JW. The psychological function of function words. In: Fiedler K, editor. Social communication: Frontiers of social psychology. New York, NY, USA: Psychology Press; 2007. pp. 343–359.
    1. Cooper LA, Roter DL, Carson KA, Beach MC, Sabin JA, Greenwald AG, Inui TS. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. American Journal of Public Health. 2012;102:979–987.
    1. Dino A, Reysen S, Branscombe NR. Online interactions between group members differing in status. Journal of Language & Social Psychology. 2009;28:85–93.
    1. Dovidio JF, Gaertner SL. Intergroup bias. In: Fiske ST, Gilbert D, Lindzey G, editors. Handbook of social psychology. Hoboken, NJ, USA: John Wiley & Sons, Inc.; 2010. pp. 1084–1121.
    1. Eggly S, Harper FW, Penner LA, Gleason MJ, Foster T, Albrecht TL. Variation in question asking during cancer clinical interactions: A potential source of disparities in access to information. Patient Education & Counseling. 2011;82:63–68.
    1. Epstein RM, Street RL. Patient-centered communication in cancer care: Promoting healing and reducing suffering. Bethesda, MD: National Cancer Institute; 2007.
    1. Fiedler K, Friese M, Wänke M. Psycholinguistic methods in social psychology. In: Klauer KC, Stahl C, Voss A, editors. Cognitive methods in social psychology. New York, NY: Guilford Press; 2011. pp. 206–235.
    1. Gordon HS, Street RL, Jr, Sharf BF, Souchek J. Racial differences in doctors’ information-giving and patients’ participation. Cancer. 2006;107:1313–1320.
    1. Greenwald AG, McGhee DE, Schwartz JLK. Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality & Social Psychology. 1998;74:1464–1480.
    1. Greenwald AG, Nosek BA, Banaji MR. Understanding and using the implicit association test: I. An improved scoring algorithm. Journal of Personality & Social Psychology. 2003;85:197–216.
    1. Hagiwara N, Penner LA, Gonzalez R, Eggly S, Dovidio JF, Gaertner SL, Albrecht TL. Racial attitudes, physician-patient talk time ratio, and adherence in racially discordant medical interactions. Social Science & Medicine. 2013;87:123–131.
    1. Hamel L, Chapman R, Malloy M, Eggly S, Penner LA, Shields AF, Albrecht TL. The critical shortage of African American medical oncologists in the United States. Journal of Clinical Oncology. 2015
    1. Hancock JT, Beaver DI, Chung CK, Frazer J, Pennebaker JW, Graesser AC, Cai Z. Social language processing: A framework for analyzing the communication of terrorists and author-itarian regimes. Behavioral Sciences of Terrorism & Political Aggression. 2010;2:108–132.
    1. Hardin JW, Hilbe JM. Generalized estimating equations. Boca Raton, FL: Chapman & Hall/CRC; 2003.
    1. Hausmann LR, Myaskovsky L, Niyonkuru C, Oyster ML, Switzer GE, Burkitt KH, Boninger ML. Examining implicit bias of physicians who care for individuals with spinal cord injury: A pilot study and future directions. Journal of Spinal Cord Medicine. 2015;38:102–110.
    1. Hing E, Lin S. NCHS data brief no 13. Hyattsville, MD, USA: National Center for Health Statistics; 2009. Role of international medical graduates providing office-based medical care: United States, 2005–2006. The report was retrieved online as well: .
    1. Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient-physician communication during medical visits. American Journal of Public Health. 2004;94:2084–2090.
    1. Kacewicz E, Pennebaker JW, Davis M, Jeon M, Graesser AC. Pronoun use reflects standings in social hierarchies. Journal of Language & Social Psychology. 2014;33:125–143.
    1. Kahn JH, Tobin RM, Massey AE, Anderson JA. Measuring emotional expression with the Linguistic Inquiry and Word Count. American Journal of Psychology. 2007;120:263–286.
    1. Kinsman H, Roter D, Berkenblit G, Saha S, Korthuis PT, Wilson I, Beach MC. “We’ll do this together”: The role of the first person plural in fostering partnership in patient-physician relationships. Journal of General Internal Medicine. 2010;25:186–193.
    1. Levin S, Federico CM, Sidanius J, Rabinowitz JL. Social dominance orientation and intergroup bias: The legitimation of favoritism for high-status groups. Personality & Social Psychology Bulletin. 2002;28:144–157.
    1. McConahay JB. Modern racism, ambivalence, and the modern racism scale. In: Dovidio JF, Gaertner SL, editors. Prejudice, discrimination, and racism. Orlando, FL: Academic Press; 1986. pp. 99–125.
    1. Mendes WB, Gray HM, Mendoza-Denton R, Major B, Epel ES. Why egalitarianism might be good for your health: Physiological thriving during stressful intergroup encounters. Psychological Science. 2007;18:991–998.
    1. Mertz E, Jain R, Breckler J, Chen E, Grumbach K. Foreign versus domestic education of physicians for the United States: A case study of physicians of South Asian ethnicity in California. Journal of Health Care for the Poor & Underserved. 2007;18:984–993.
    1. Nosek BA, Greenwald AG, Banaji MR. The implicit association test at age 7: A methodological and conceptual review. In: Bargh JA, editor. Social psychology and the unconscious: The automaticity of higher mental processes. New York, NY, USA: Psychology Press; 2007. pp. 265–292.
    1. Page-Gould E, Mendoza-Denton R, Tropp LR. With a little help from my cross-group friend: Reducing anxiety in intergroup contexts through cross-group friendship. Journal of Personality & Social Psychology. 2008;95:1080–1094.
    1. Patton MQ. Qualitative research & evaluation methods. 3rd. Thousand Oaks, CA: Sage Publication; 2015.
    1. Pennebaker JW, Booth RJ, Francis ME. Linguistic Inquiry and Word Count (LIWC2007): A computer-based text analysis program [Computer software] Austin, TX: ; 2007.
    1. Pennebaker JW, Chung CK, Ireland M, Gonzales A, Booth RJ. The development and psychometric properties of LIWC2007. [Software manual] Austin, TX: ; 2007.
    1. Penner LA, Blair IV, Albrecht TL, Dovidio JF. Reducing racial health care disparities: A social psychological analysis. Policy Insights from the Behavioral & Brain Sciences. 2014;1:204–212.
    1. Penner LA, Dovidio JF, West TW, Gaertner SL, Albrecht TL, Dailey RK, Markova T. Aversive racism and medical interactions with Black patients: A field study. Journal of Experimental Social Psychology. 2010;46:436–440.
    1. Penner LA, Hagiwara N, Eggly S, Dovidio JF, Gaertner SL, Albrecht TL. Racial healthcare disparities: A social psychological analysis. European Review of Social Psychology. 2013;24:70–122.
    1. Pratto F, Sidanius J, Stallworth LM, Malle BF. Social dominance orientation: A personality variable predicting social and political attitudes. Journal of Personality & Social Psychology. 1994;67:741–763.
    1. Sabin JA, Nosek BA, Greenwald AG, Rivara FP. Physicians’ implicit and explicit attitudes about race by MD race, ethnicity, and gender. Journal of Health Care for the Poor & Underserved. 2009;20:896–913.
    1. Sabin JA, Rivara FP, Greenwald AG. Physician implicit attitudes and stereotypes about race and quality of medical care. Medical Care. 2008;46:678–685.
    1. Scholand AJ, Tausczik YR, Pennebaker JW. Social language network analysis. Proceedings of CSCW 2010; ACM Press; February 6–10, 2010; Savannah, GA, USA. 2010. pp. 23–26.
    1. Sexton JB, Helmreich RL. Analyzing cockpit communications: The links between language, performance, and workload. Human Performance in Extreme Environments. 2000;5:63–68.
    1. Shavers VL, Fagan P, Jones D, Klein WM, Boyington J, Moten C, Rorie E. The state of research on racial/ethnic discrimination in the receipt of health care. American Journal of Public Health. 2012;102(5):953–966.
    1. Sidanius J, Pratto F. Social dominance: An intergroup theory of social hierarchy and oppression. Cambridge, UK: Cambridge University Press; 1999.
    1. Siminoff LA, Graham, Gordon NH. Cancer communication patterns and the influence of patient characteristics: Disparities in information-giving and affective behaviors. Patient Education & Counseling. 2006;62:355–360.
    1. Slatcher RB, Vazire S, Pennebaker JW. Am “I” more important than “we”? Couples’ word use in instant messages. Personal Relationships. 2008;15:407–424.
    1. Smedley BD, Stith AY, Nelson AR. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, D.C., USA: National Academies Press; 2003.
    1. Stephan WG, Stephan CW. Intergroup anxiety. Journal of Social Issues. 1985;41:157–175.
    1. Tausczik Y, Pennebaker JW. The psychological meaning of words: LIWC and computerized text analysis methods. Journal of Language & Social Psychology. 2010;29:24–54.
    1. Wilson TD, Lindsey S, Schooler TY. A model of dual attitudes. Psychological Review. 2000;107:101–126.

Source: PubMed

3
订阅