Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults

This study was based on the belief that racial and ethnic minorities are more likely to mistrust the healthcare system. Since there is not much information about the effects of this mistrust, the authors set out to investigate any associated consequences to this belief, and theorized that if perceived discrimination causes medical mistrust, then taking actions to decrease such discrimination may improve trust in medicine and help with disparities in health outcomes.

The authors used a cross-sectional survey with California state residents between June 2019 to July 2019. Survey participants were invited via the Ipsos Knowledge Panel, and non-Hispanic Black participants were oversampled. A total number of 2,588 adults were included, of which 35% were non-Hispanic White, 28% were non-Hispanic Black, 27% were Hispanic. Data collected included demographic questions, as well as questions that perceived level of discrimination for the participants. The scale to measure perception of discrimination included six questions measured the perception of discrimination due to income and type of or lack of insurance, and four questions measured the perception of discrimination due to race/ethnicity and language. It was crucial to use “perceived” level of discrimination rather than true level of discrimination because patients’ perception of discrimination is what will actually leads to mistrust. The primary outcome variable was level of medical mistrust among participants. This construct was measured using a single question asking, “In general, how much do you trust your health care providers to act in your best interest?”.

The results showed that there was a statistically significant difference between non-Hispanic Black and Hispanic participants as compared to non-Hispanic White participants regarding perceived discrimination for both income and insurance and race/ethnicity and language. The results also showed that level of trust correlated with perceived discrimination due to income and type of or lack of insurance.

One of the main limitations of the study was that it only included California residents. Thus, the study can be generalized only to populations that are similar in demographics, health and social practices. Our group discussed the importance of investigating these issues on a larger, national basis to study perceived discrimination to generalize to the entire US population. We also discussed including questions about diversity among providers, such as “would you feel more comfortable with a provider that looks like/resembles you or speaks the same language as you?”.

We discussed the importance for providers to recognize their implicit biases as there are direct implications on the mistrust of patients on patient care and adherence to treatment However, there are also many larger, contributing factors that exist in society that pose as challenges to providers overcoming these barriers such as lack of time for patient visits and limited resources available especially in rural and underserved communities. We recommended the use of in-house social workers as part of a multidisciplinary team to help bridge the care of a patients’ physical health with the social aspects of their healthcare. The authors’ recommendation of bias training was also appreciated and we agreed it should be further implemented into the medical school and residencies curriculum.

Furthermore, in light of the current coronavirus pandemic (COVID-19), the authors also noted how perceived discrimination and medical mistrust may affect patients’ who do not have primary care physicians (PCP). Since there has been a significant increase in virtual “tele-health” visits, there is a dilemma that exists for populations that do not have a PCP or technology available for this evolving health care service. We agree this poses another opportunity for mistrust among patients’ as it may promote further marginalization.