Health

Doctors are less likely to respond to Black patients, study finds

Researchers found patients belonging to minority groups were less likely to hear back from doctors on their patient portals.

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If you're trying but failing to reach your doctor through a patient portal, your race may be at play.

That's the finding from a new study published in JAMA Network Open, which suggests patients who belong to minority racial and ethnic groups are less likely to receive a response from a physician. Instead, these patients will more likely hear back from nurses, which the study says insinuates a "lower prioritization during triaging."

Researchers came to this conclusion after examining the patient portal messages of 39,043 Boston Medical Center patients in 2021. After 11 months, their data showed the likelihood of receiving any response was similar regardless of race, but it was the type of health care professional responding that differed.

Namely, Black patients were nearly 4 percentage points less likely to get a response from an attending physician and about 3 percentage points more likely to hear from a registered nurse, the study shows. Asian and Hispanic patients saw similar but smaller results, with the former being 2.11 points less likely to receive a physician's response and the latter 2.32 points less, the study shows.

Meanwhile, White patients, being only 21.1% of the studied group, received 46.4% of all physician responses, the researchers said.

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The finding comes as online patient portal use has been on the rise in recent years, particularly due to the pandemic. A report from the Office of the National Coordinator for Health Information Technology showed nearly 40% of Americans accessed a patient portal in 2020, marking a 13 percentage point increase since 2014, as patients' ability to get face-to-face health services was disrupted. 

But a previous JAMA study showed that although the portals gave patients a secure place to access health information at any time, there are still disparities hindering greater adoption into the health care industry. These include health literacy, socioeconomic status, education levels and other related demographics that subsequently resulted in lower portal access and use for patients in racial and ethnic minority groups.

It wasn't until this study, published Monday, that researchers looked into whether there were differences in experiences for the patients in minority groups who did access and use their portals. 

But where difference in use was attributed to the demographics listed above, researchers say message-response disparities could be attributed to racial bias within health care. They note national surveys have shown nearly 20% of patients have reported experiencing racial discrimination in health care communications. 

The study suggests the triaging nurses who decide to forward messages to attending physicians may send fewer from patients in minority groups, either due to a difference in communication style, the "underlying message request" or implicit bias.

That's where health literacy may again play a role, according to the study. Researchers said a lower level of overall health literacy may reflect in the type and manner of request made through the portal, which could impact the health care professional's response.

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The researchers in the study acknowledge there may be limitations to their findings, like its inclusion of only one single health care system. This may be too focused to apply to the industry as a whole.

And while not all portal response variability is a cause for concern, the study suggests further work should be done to determine the root of the disparities between whether a nurse or physician responds to a patient belonging to a racial or ethnic minority group.