A Qualitative Study of African-American and Latinos' Attitudes about the Role of Implicit Bias and Race/Ethnicity in Perceived Quality of Personal Treatment and Medical Decision-Making

Background: Studies document bias and stereotyping by physicians based on patient race, which can lead to inequalities in care delivery. It is critical to explore patients' perception of physician bias impacting the perceived quality of care. Methods: Focused Discussion Groups (FDG) with 45 African American and Latino community members stratified by age and self-identified race/ethnicity and led by race/ethnic-concordant moderators. Participants were asked about their personal experiences and treatment within the healthcare system and to discuss the importance of race, ethnicity and personal experiences related to quality of care in two care delivery systems. Common themes were identified using the software package ATLASti. Results: 28 of 45 participants self-identified as AA/Black and 14 as Latino; 3 identified as “other”. Regardless of their own race/ethnicity, participants believed that patient race/ethnicity and age negatively influenced patient-provider interaction and quality of care. Latino participants indicated that provider race is a central factor for initially selecting a provider and perceive their own race/ethnicity negatively impacts quality of care, whereas AA participants did not equally share these sentiments. In spite of this difference, Latino participants seemed less likely to act on and challenge providers with their perception of an implicit bias compared to their AA/Black peers. Conclusion: This investigation adds to our understanding about how patients perceive their patient-physician provider relationship in the United States and offers data to suggest we should provider race/ethnicity, cultural competence and potential bias when treating patients.