Hospital consumer reviews can reveal discrimination

Consumers aren’t shy about saying what they didn’t like about their experience in a hospital, and some of those reviews can reveal acts of racism and discrimination.

Hospitals shouldn’t just look away from those reviews posted online. In a study published on Jama Network Open, researchers at the University of Pennsylvania examined consumer reviews revealing incidents of racism and discrimination.

Hospitals should be looking at those reviews to reduce bias and discrimination. They also will find improvement in patient care if they do, the authors said.

“These manifestations of discrimination might result in harm to individuals and lead to inequities in care,” the Penn researchers wrote.

Providers should also see instances of discrimination "as a form of patient harm," the authors state. Healthcare organizations can use online reviews from patients and consumers and use them as tools to improve.

The researchers examined more than 10,000 reviews and found nearly 3,000 reviews that could be potentially linked to discrimination. From there, the researchers identified 182 reviews that had at least one act of discrimination.

Nearly half of the reviews (48.9%) mentioned acts of discrimination in clinical areas where consumers were receiving or awaiting treatment. About one in three reviews (36%) involved consumers directing discrimination at healthcare workers. And nearly 14% of the acts took place in nonclinical areas, such as lobbies, the study found.

Six patterns of discrimination

The study found six recurring patterns of discrimination: acts of commission, omission, dehumanizing, stereotyping, intimidation, and unprofessionalism.

The authors included some disturbing examples, without naming facilities.

Commission: Some reviews described verbal or even physical abuses, including a patient describing sexual harassment by a clinician. Another said nurses on a unit were “extremely racist.” Nurses have complained of widespread racism in the industry, with complaints falling on deaf ears. Reviewers said they were warned about filing grievances, including threats of adding notes to patient records that could affect care.

Omission: These acts involved the neglect or delays in patients’ basic needs, such as food or assistance with activities. Some of these involved ignoring descriptions of pain, which led to a delayed or missed diagnosis. Some acts continued even after patients and their advocates complained.

Dehumanizing: Patients described instances of being treated as if they didn’t matter. One patient said, “Why wasn't I greeted with enthusiasm, let alone greeted at all? Was it because of the color of my skin?” Another said a staff member opened the gown of an older patient in front of another individual.

Stereotyping: Patients, particularly Black patients, said clinicians demonstrated their bias by overlooking symptoms. Black women said doctors ignored their pain and attributed it to attempts to get medication due to an addiction. One patient said, "I realized I was being judged, singled out, possibly because of my ethnicity, it being late at night and in my pajamas."

Intimidation: Patients described staff using medical procedures as justification to invade their privacy. One patient said she was told she had to undress and put on a gown in front of a staff member. Women and older patients described incidents of bullying or intimidation.

Unprofessionalism: Patients described staff with terms such as mean, rude or condescending. A patient in a same-sex couple said the joy of the birth of their first son “was quickly overshadowed by the behavior of some, if not most of the staff. Most of the nurses and any doctor we saw basically completely refused to acknowledge my presence.”

What can be done

The study’s authors said understanding those six patterns of inappropriate behavior can offer a framework for improvement.

Hospitals and healthcare organizations can identify issues of discrimination and start educational efforts and other interventions. They need to measure to evaluate if their institutions are making gains or falling short. And hospitals need to continually monitor to identify signs of discrimination and take concrete steps to reduce them.

Racism and bias in healthcare continues to gain more attention as the federal government and some healthcare leaders seek to address disparities in treatment of patients in minority groups.

Electronic health records demonstrate bias, with Black patients and those with lower incomes described more negatively than patients who are white or are more affluent, according to a recent study in Health Affairs.

Some healthcare advocates point out that a more diverse healthcare workforce will likely reduce bias and discrimination in patients.

Women account for about one-third of all doctors. Only 5% of America’s doctors are Black, and 5% of the nation’s physicians are Latino, according to data from the Association of American Medical Colleges.