"I think it's nothing. You'll be fine." Exploration of racially biased clinician communication behaviors

Numerous medical education interventions seek to mitigate racial inequities in healthcare delivery by addressing racial bias. While awareness of racial bias is important, it is not sufficient to promote behavior change. Given the well-studied relationship between clinicians' racial biases and their communication behaviors with black compared to white patients, communication presents a promising target. However, little is known regarding which specific communication behaviors to target. To inform the design of such interventions, this study explores black adults' perceptions of racially biased clinician communication behaviors.

Focus group discussions with self-identified black adults (n = 33) were conducted in 2023. Participants were recruited through online platforms. Six 60-minute focus group discussions were conducted via zoom. A coding scheme was developed through iterative analysis of the interview transcripts. All interview transcripts were then coded with the goal of identifying clinician communication behaviors perceived as racially biased.

Five key themes were identified: (1) embodied bias, (2) neglect in plain sight, (3) interpersonal devaluation, (4) systematic disregard and disbelief and (5) medical authoritarianism.

Clinicians engage in specific communication behaviors that signal racial bias to their patients. Our results reflect not only communication breakdowns but the racial epistemic conditions that shape medical encounters with racially minoritized patients.

Future curricular interventions can utilize these findings as the foundation for enhancing communication skill development and promoting behavior change amongst clinicians.