A Qualitative Exploration of Primary Care Clinicians' Perceptions of Hypertensive Black Patients

Black Americans experience stereotyping when receiving care, harming the therapeutic relationship and likely contributing to inequities in hypertension management. Although patients have described these experiences, there is limited understanding from clinicians' perspectives.

We conducted an Interpretive Description study with 30 Minnesota family medicine physicians between July and September 2023 to explore the assumptions associated with hypertensive Black patients, as perceived by the clinicians. Transcripts were analyzed and themes developed using thematic analysis with inductive and deductive approaches.

Participants observed that they, or their colleagues (1) viewed Black patients as having hypertension that was more challenging to manage due to factors outside the clinicians' control, and (2) changed their approach to Black patients' hypertension management in response to assumed difficulty. Participants viewed Black patients as less willing and able to manage their hypertension due to mistrust and biological, behavioral, and social factors. Perceived barriers to hypertension management overlapped with what participants described as stereotypes of Black patients, and a few participants acknowledged that clinicians may convey their lower expectations of Black patients through disinvestment in their care.

Participants viewed Black patients as having greater challenges with hypertension control due to factors that were seen as being indiscriminately assumed of these patients, potentially resulting in reduced clinician engagement. As such, clinicians must balance their knowledge of population-level disparities with an individualized approach to patient care. To reduce stereotyping of Black patients, it is crucial to pay closer attention to how population-level differences are discussed and applied.