One study demonstrated that sociodemographic factors created additional access

barriers for Hispanic patients with diabetes resulting in lower utilization of healthcare
and higher disease management expenditures. The same study found that Hispanic
patients with diabetes were typically younger, but had higher poverty rates, less
education, and lower physical activity levels when compared to non-Hispanics in the
general U.S. population.
exository essay
Econmic status
Race
Sexual orientation
Gender
Religion
Obesity
Education= if they are corrected by patients are they intimidated. Doctors assume that patient don’t
know about what they do or are on their level

What - social biases affect the relationship between patient

and health care worker
Who - both sides
Eg- how doctor treat people with low income and how are they affected

Economic status The role of Economic status and its impact on patient treatment is well
established, as is the fact that patients with low income status or display signs of
poverty tend to be poorly attended to by health-care workers
Why- physician have a preference with caring for those financially stable because
they know they will be paid
Privilege
Example
The stunting of physical growth
and cognitive development
Economically advantaged people have better health outcomes than the less
advantaged.
One study demonstrated that a person’s neighborhood of residence can predict
cardiovascular mortality. Low socioeconomic status is known to be linked to
increased cardiovascular risk factors. The results of another empirical analysis
showed that those with higher perceived socioeconomic standing and greater
resources have better health than those who have lower standing and fewer resources.
In this study, self-reported health, dental health, and happiness were strongly
associated with subjective assessments of social position.

Many claim that the prioritization of daily necessities for disadvantaged populations
can become a way of life, which can sometimes mean that health needs are postponed
or not addressed at all when resources are scarce.but there cases when patients are not
attended to because healthcare workers come to a conclusion about the patients
economic status even before communication with patients.Dr. James Mann, an
Internal Medicine Resident at The Ohio State University Wexner Medical Center,
recalls several instances while he was working in the Emergency Department as an
aid (before he entered medical school), where physicians or other medical staff made
incorrect assumptions about patients because the patient was homeless or
underprivileged.

Constraints
The physician-patient relationship can become challenged by the lack of
understanding of the patient circumstances, or by challenges with the patient’s
compliance with treatment.

Patient perspectives of the physician/patient relationship were also thought to

contribute to problems with compliance or treatment adherence.
Challenges with patient compliance can also stem from misconception about privilege
and discrimination, as suggested by a recent study that found that patient-perceived
discrimination in health care tends to promote the under-utilization of health services,
including preventive screenings, medical testing, and acute treatment. This study
suggested that patients who perceive socioeconomic status discrimination by
providers in the health care system may have lower levels of compliance, and report
lower satisfaction with care or with patient-physician communication.
Many studies have shown that doctors treat lower-income patients
differently than their wealthier counterparts, LaVeist said. Those of
higher means are more likely to receive better pain management,
suffer fewer instances of medical errors and have lower readmission
rates to hospitals.

Research is also starting to look at how implicit bias affects the dynamics of
physician-patient relationships and subsequent care for patients with
particular diseases, such as cancer and diabetes.

Lgbt - uncomfortable and scorned

Race
In 2003, the concepts received an empirical boost from “Unequal Treatment,” a
report from an Institute of Medicine (IoM) panel made up of behavioral
scientists, physicians, public health experts and other health professionals.
The report concluded that even when access-to-care barriers such as
insurance and family income were controlled for, racial and ethnic minorities
received worse health care than nonminorities, and that both explicit and
implicit bias played potential roles.

Psychologists and others are now building on the IoM findings by exploring
how specific factors, including physicians’ use of patronizing language and
patients’ past experiences with discrimination, affect patients’ perception of
providers and care. Research is also starting to look at how implicit bias
affects the dynamics of physician-patient relationships and subsequent care
for patients with particular diseases, such as cancer and diabetes.

The team found that black patients felt most negatively toward physicians who
were low in explicit bias but high in implicit bias, demonstrating the validity of
the implicit-bias theory in real-world medical interactions
Researchers are also examining ways that providers may inadvertently
demonstrate such bias, including through language. In a study in Social
Science & Medicine (Vol. 87, 2013), Nao Hagiwara, PhD, at Virginia
Commonwealth University, and colleagues found that physicians with higher
implicit-bias scores commandeered a greater portion of the patient-physician
talk time during appointments than did physicians with lower scores. Those
findings are consistent with research by Lisa A. Cooper, MD, of Johns
Hopkins University School of Medicine and colleagues, who found that
physicians high in implicit bias were more likely to dominate conversations
with black patients than were those lower in implicit bias, and that black
patients trusted them less, had less confidence in them, and rated their quality
of care as poorer

In a study of black cancer patients and their physicians, Penner, Dovidio and
colleagues found that, overall, providers high in implicit bias were less
supportive of and spent less time with their patients than providers low in
implicit bias. And black patients picked up on those attitudes: They viewed
high-implicit-bias physicians as less patient-centered than physicians low in
this bias. The patients also had more difficulty remembering what their
physicians told them, had less confidence in their treatment plans, and
thought it would be more difficult to follow recommended treatments (Journal
of Clinical Oncology, Vol. 34, No. 24, 2016).

In another study, Penner and colleagues looked more specifically at how past
discrimination may influence black cancer patients’ perception of care and
their reactions to it. Patients who reported high rates of past discrimination
and general suspicion of their health care talked more during sessions,
showed fewer positive emotions and rated their physicians more negatively
than those who reported less past discrimination and lower suspicion (Social
Science & Medicine, Vol. 191, 2017)

Another promising intervention, the prejudice habit-breaking intervention,

endorsing racial stereotyping,

Psychologists who study implicit bias in health care acknowledge there is

much more to learn. That includes discovering ways that patient-physician
interactions might lead to poorer health outcomes down the road, and
conducting research on other populations besides black patients and
nonblack physicians

To achieve health equity, health care organizations have a responsibility to mitigate the
effect of implicit bias in all interactions and at all points of contact with patients. This is
important because implicit bias has the potential to impact not only outcomes of care, but
also whether patients will return for services or even seek care at the organization in the
first place. While a majority of research on implicit bias in health care focuses on racism,
other social factors such as primary spoken language, gender, sexual orientation,
education, and employment status are also associated with implicit bias and differences
in communication and treatment.
Implicit bias may affect how providers and other clinicians interact with patients in terms
of communication, treatment protocols or recommended treatment options, or options for
pain management. Implicit bias can affect both perception and clinical decision making,
and studies show that implicit bias is significantly related to patient-provider interactions
and treatment decisions. One study found that a substantial number of medical students
and residents held false beliefs about biological differences between white and black
individuals (such as believing that black skin is “tougher” than white skin), and found that
these beliefs predict racial bias in pain treatment recommendations.
Since black patients are more likely than white patients to die in the ICU receiving life-
sustaining treatment rather than in hospice receiving comfort care, Elliott and colleagues
tested whether physicians use different verbal and/or nonverbal communication when
having end-of-life care conversations with black and white patients and family members.
They found that while verbal communication was similar, nonverbal communication
scores were significantly lower with black patients than with white patients, with fewer
positive, rapport-building behaviors. This difference can affect the outcome of the end-of-
life care conversations and contribute to a higher incidence of black patients dying in the
ICU while receiving life-sustaining treatments rather than dying at home.
Implicit bias can negatively affect other elements of patient interaction with the health
care system. A 2015 study found that racial/ethnic minorities, individuals with lower levels
of education, and unemployed individuals spend significantly longer time waiting to obtain
medical care, with blacks and Latinos waiting 19 and 25 minutes more, respectively, than
white patients to see a doctor. In addition, anxiety about interactions with people of color
can result in white providers spending less time with patients

This impacts trust and the likelihood that patients will seek health care.

Another promising intervention, the prejudice habit-breaking intervention,

endorsing racial stereotyping,

The team found that black patients felt most negatively toward physicians .

Sexual orientation
Gender

Opening paragraph When patients enter the health care system, particularly when they
are experiencing a life-threatening health problem, we implicitly assume that the care
they receive is dictated by sound clinical judgment and objective, evidence-based
practice parameters derived from reliable research. Nowhere in that scenario do we
anticipate that clinical decision making will be influenced by patient attributes such as
religion, nationality, or socioeconomic class or any other feature not relevant to their
specific clinical situation. \ some aspects of health care services are tilted to favor one
segment of the population while disfavoring another
Evidence of the disfavoring of women in health care services was found. .In health care, gender bias
primarily refers to instances in which female patients are assessed, diagnosed, referred, and treated not
only differently but at a lower level of quality or to a lesser degree of adherence to established
standards of care than men with comparable health problems. This inequality can lead to comparatively
worse outcomes for women, marked by higher complication rates, higher morbidity, and higher
mortality. According to a recent women are offered surgery less often in every
age group studied for carotid endarterectomy. this suggests that factors
beyond age and surgical risk may influence whether physicians offer this
surgical option to women. The findings are more concerning, given that the
female gender is itself a known and negative risk factor for vascular
interventions in peripheral arterial disorders.Another study showed that heart
disease is the No. 1 killer of women, but all too often, women are not properly
screened for heart disease when they go for a primary care check-up.Other
studies have shown that the mortality rate among women in the
hospital was higher than that among men. That was because treatment
was sought for women only when they had serious ailments.Compared
with male patients, women who present with the same condition may not
receive the same evidence-based care. In several key areas, such as
cardiac care and pain management, women may get different treatment,
leading to poorer outcomes. Patient - physician relationship is definitely;y challenged
because women feel that Some physicians take their symptoms less seriously, Physician have neglected
them because they believe their Symptoms are reflections of their emotions rather than physical
causes.Women, more frequently than men, are told that their symptoms are ‘just
in their mind. Due to this stereotype refer women less often than men for specialty care, even
women with a relatively greater degree of disability.

In other cases women are bias to female doctor because they feel more
comfortable around them . some refuse go to a male doctor because They are
just horrified to think about having to go and undress or to be declothed in any
way or certainly to talk about things that have to do with their own personal
health. Some men prefer female doctors because of the level of comfort they
feel where in other cases men don’t trust the health care practices , treatment
and recommendation just because they are women.

In other scenarios gender dias can often be mistaken for fear . A recent
study found that women are less likely than men to get CPR from a bystander,
and are more likely to die. This is because some men are feaful of hurting
them, or even being accused of sexual assault.Gender bias can arise from either assuming
sameness and/or equity between the genders where genuine differences in anatomic physiology,
pathophysiology, course, or response to treatment actually exist or from assuming differences exist
when they do not.Either instance may evoke erroneous, stereotypical views about men or women that
may influence how health care professionals practice and provide care. It was found that Young
women were more likely to be told to lose weight, where the young men who
were actually more overweight were more likely to be put on effective
preventive therapyEven though women are more likely than men to die in the
year following a heart attack, all too often, women aren’t prescribed
medication that could lower their risk of a heart attack, Bairey Merz said.
Instead, they are likely to be instructed by their physicians to lose
weight.“People are always sort of judging women according to their weight,"
Bairey Merz told the Today Show. “The irony, of course, is that weight loss
doesn’t reduce cardiovascular disease.”
Differences between the genders are quite common and merit recognition, but when
differences in care are due to bias, a more overriding concern demands our attention
owing to the potential for harm.
a study this month found that women are less likely than men to get CPR from
a bystander, and are more likely to die.
“Young women were more likely to be told to lose weight, where the young
men who were actually more overweight were more likely to be put on
effective preventive therapy,” Bairey Merz said.
Even though women are more likely than men to die in the year following a
heart attack, all too often, women aren’t prescribed medication that could
lower their risk of a heart attack, Bairey Merz said. Instead, they are likely to
be instructed by their physicians to lose weight.
“People are always sort of judging women according to their weight," Bairey
Merz told the Today Show. “The irony, of course, is that weight loss doesn’t
reduce cardiovascular disease.”
“Biases are not moral failings; they are habits of mind,”
A good interpersonal relationship between a patient and provider, as
characterized by mutual respect, openness, and a balance in their
respective roles in decision-making, is an important marker of quality of
care

The fear of lgbtq patients being discriminated by health care work

hinders communication, interaction and eventually no relationship
development. Reseach has confirmed that health cvare providers have a
preference for
patients that had the same sexual identification. Unsurprisingly, heterosexual health care
providers showed moderate to strong implicit preferences for heterosexual patients. Interestingly
enough, the same result was found in lesbian and gay health care providers who also displayed
both implicit and explicit preferences to treat lesbian and gay patients. Bisexual providers proved
to be more indecisive, showing mixed preferences. There were also variations based on the type of
health care profession certain participants occupied; for instance, mental health care providers
showed the weakest implicit bias for sexual preferences, while nurses had the strongest preference
for heterosexual patients over lesbian and gay patients. 

These thoughts are not uncommon among LGBT individuals when interacting
with healthcare professionals and their fears are not unwarranted. Studies have
shown both concious and unconcious bias among heterosexual healthcare
providers against LGBT patients.

The fear of discrimination is toxic to proper healthcare and can even prevent
individuals from seeking medical attention. In an environment where the patient
fears interacting with their physician, there is an inevitable breakdown in
communication and subsequent failures to fully address the medical needs of that
individual are likely. This fear of discrimination represents a major barrier that
exists between LGBT patients and healthcare workers..According to Medical
Daily, instances of discrimination by healthcare workers toward LGBT people
are more common than you may realize. For example, in a study published in
the journal Health and Social Work, 42% of female-to-male transgender
adults reported being confronted with verbal harassment, physical assault or
flat out denial of treatment at hospitals and doctors' offices.Staff and
providers may also benefit from education on potential health disparities in
the LGBT patient community, such as higher substance abuse rates, higher
rates of anxiety and depression, a higher incidence of HIV/AIDS and an
increased incidence of certain cancers

Because both the patient and the providers are refuse to interact
with eachother, it can lead to other dilemmas. According to Johnson and
Nemeth, after experiencing providers’ discriminative attitudes and biases, lesbian
patients sought health knowledge via the Internet instead of attaining a professional
recommendation,3 which can lead to misinformation from unreliable sources. Others
disguised their sexual orientation or avoided seeking further care altogether, which
can delay health screenings, resulting in an undiagnosed or exacerbated untreated
medical illness.