Preferring patient–physician concordance: the ambiguity of implicit ethnic bias

Abstract

ABSTRACT Background: Much of the current literature on racial/ethnic bias in healthcare focuses on practitioners’ implicit biased attitudes regarding patients, identifying it as a factor contributing to health disparities. Little attention has been paid, however, to patients’ bias against practitioners from other ethnic group. Aim: To explore patients’ bias towards practitioners from other ethnic group. Method: In-depth interviews were conducted during 2018 with 38 Israeli Jewish and Arab patients. Findings: While many participants (more Jews than Arabs) reported that they perceive medical treatment as neutral and value the physician’s professionalism and attitude, others (more Arabs than Jews) attested that they do prefer to be treated by physicians of their own ethnic group. Jewish patients who prefer Jewish physicians described bias against Arab physicians: Feelings of fear and distrust, particularly in light of the conflictual situation in Israel. They also considered Arab physicians less professional than Jewish ones. Arab patients who prefer Arab physicians described their need for culturally and linguistically competent healthcare and praised close informal relations with Arab physicians, contrasting them with past offensive and humiliating experiences with Jewish physicians. Conclusions: Findings reveal several factors that impact Jewish and Arab Israeli patients’ preference for patient–physician concordance, some of which reflect patients’ implicit bias. This phenomenon – together with practitioners’ implicit bias against patients – should be recognized as contributing to the ambiguity of ethnic relations in clinical encounters, particularly in conflictual societies.