Biais in Healthcare: Doctor-Patient Communication
How patients' racial identity shapes medical communication
Healthcare disparities persist in the United States, with Black patients often receiving lower-quality care. Effective doctor-patient communication is a key driver of satisfaction, treatment adherence, and health outcomes. This project, conducted in the United States in collaboration with Markus Brauer (University of Wisconsin-Madison), starts from a simple question: what differs in doctor-patient communication depending on a patient’s racial identity?
Study 1: Real clinical encounters. A first study analyzed oncology consultations between a physician and a standardized patient actor, delivering a diagnosis of a rare blood cancer. This study revealed systematic differences in physician communication depending on the patient’s racial identity.
Study 2: Are these differences perceptible in writing, out of context? Having established these differences, we asked whether they remained perceptible when physician speech was transcribed and rated by observers blind to both physician and patient identity. The answer was yes: physicians’ speech was subject to genuine polarization. White American observers rated physicians negatively when addressing a Black patient, and positively when addressing a White patient. Black American observers showed the same bias, but markedly attenuated — rating physicians addressing a Black patient noticeably more leniently.
Study 3: Does this bias reflect different expectations? One question remained: do these communication differences simply reflect different expectations between Black and White American patients? Our results show they do not: expectations differ little between the two groups, and where they do differ, Black American patients express a stronger preference for more patient-centered, positive communication — the opposite of what we observe in our earlier studies and in the existing literature.
This work is ongoing: understanding where and how these biases take hold in medical communication is a critical step toward identifying concrete levers for change, and toward more equitable care for all patients.