they felt they experienced more racial bias from medical staff than
from physicians.
People of color and other underrepresented populations also experi-
ence something called "stereotype threat." These patients are aware
of negative stereotypes about their cultures and they expect to be
stereotyped by their healthcare providers, particularly if the provider
is of a different race or cultural background. For example, black
Americans may be viewed as lacking education or women may be
viewed as being less talented in math or science. The awareness of
these stereotypes makes them anxious, impairing cognitive perform-
ance and working memory. They may struggle to accurately share the
information that providers need, or they may misrepresent informa-
tion specifically to avoid conforming to the expected stereotype.
Interactions between clinicians and these patients are shorter, fre-
quently unpleasant and feature little patient involvement or shared
decision-making. Patients may have trouble focusing on the informa-
tion the provider gives them, which may impact their abilities to
adhere to post-op instructions. As a result, these patients may struggle
with compliance and experience poorer outcomes than their white
counterparts who do not have such stereotypes or cultural barriers to
overcome.
5
Fear of being stereotyped can also cause patients to skip appoint-
ments and postpone needed care. People tend to avoid situations
where they feel unwelcome or where they expect devaluation. In the
past, all of this would have constituted poor patient care, but the out-
comes would have been viewed as the patients' problem. Now, though,
facilities share responsibility for these experiences and outcomes.
Thanks in part to the Affordable Care Act, bad outcomes impact
facility revenues. Medicare's Value Based Purchasing program punish-
es facilities by up to 2% of reimbursement for poor scores on items
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