Clinician-Patient Racial/Ethnic Concordance Influences Racial/Ethnic Minority Pain: Evidence from Simulated Clinical Interactions

Abstract

Objective: Racial and ethnic minorities in the United States report higher levels of both clinical and experimental pain, yet frequently receive inadequate pain treatment. Although these disparities are well documented, their underlying causes remain largely unknown. Evidence from social psychological and health disparities research suggests that clinician-patient racial/ethnic concordance may improve minority patient health outcomes. Yet whether clinician-patient racial/ethnic concordance influences pain remains poorly understood.

Methods: Medical trainees and community members/undergraduates played the role of "clinicians" and "patients," respectively, in simulated clinical interactions. All participants identified as non-Hispanic Black/African American, Hispanic white, or non-Hispanic white. Interactions were randomized to be either racially/ethnically concordant or discordant in a 3 (clinician race/ethnicity) × 2 (clinician-patient racial/ethnic concordance) factorial design. Clinicians took the medical history and vital signs of the patient and administered an analogue of a painful medical procedure.

Results: As predicted, clinician-patient racial/ethnic concordance reduced self-reported and physiological indicators of pain for non-Hispanic Black/African American patients and did not influence pain for non-Hispanic white patients. Contrary to our prediction, concordance was associated with increased pain report in Hispanic white patients. Finally, the influence of concordance on pain-induced physiological arousal was largest for patients who reported prior experience with or current worry about racial/ethnic discrimination.

Conclusions: Our findings inform our understanding of the sociocultural factors that influence pain within medical contexts and suggest that increasing minority, particularly non-Hispanic Black/African American, physician numbers may help reduce persistent racial/ethnic pain disparities.

Keywords: Clinician–Patient; Health Disparities; Pain Report; Racial/Ethnic Concordance.

Figure 1.

Simulated clinical interaction and painful medical procedure analogue design. A) Experiment room setup. B) Medical history section of the simulated clinical interaction. C) Vital signs section of the simulated clinical interaction. D) Painful medical procedure analogue using thermal heat stimulations. E) Painful medical procedure analogue design. Written and signed audio/video recording permission was obtained from depicted participants.

Figure 2.

Racial/ethnic concordance effects on patients’ perceptions of similarity with their clinician. A) Racial/ethnic concordance effect on patient-perceived ethnic similarity with their clinician by patient race/ethnicity. B) Racial/ethnic concordance effect on patient-perceived appearance similarity with their clinician by patient race/ethnicity. Dots and diamonds represent raw data points and means, lines represent medians, and asterisks represent the results of simple effects tests and interaction contrasts from linear regression models. Black = non-Hispanic Black/African American; Hispanic = Hispanic white; white = Non-Hispanic white. ^***P < 0.001; ^**P < 0.01; ^*P < 0.05; ^†P < 0.10.

Figure 3.

Racial/ethnic concordance effects on patient pain intensity and pain-induced physiological arousal. A) Racial/ethnic concordance effect on pain intensity by patient race/ethnicity. B) Racial/ethnic concordance effect on pain-induced physiological arousal during painful medical procedure analogue by patient race/ethnicity. Dots and diamonds represent raw data points and means, lines represent medians, and asterisks represent the results of simple effects tests and interaction contrasts from linear mixed effects models. Black = non-Hispanic Black/African American; Hispanic = Hispanic white; white = Non-Hispanic white; μS = microsiemens. ^**P < 0.01; ^*P < 0.05; ^†P < 0.10.

Figure 4.

Effect of clinician–patient racial/ethnic concordance on pain-induced physiological arousal moderated by racial/ethnic discrimination. A) Patients who had previously experienced racial/ethnic discrimination had lower pain-induced physiological arousal when paired with a racial/ethnic-concordant clinician. B) Patients who reported currently worrying about racial/ethnic discrimination had lower pain-induced physiological arousal when paired with a racial/ethnic-concordant clinician. Dots and diamonds represent raw data points and means, lines represent medians, and asterisks represent the results of simple effects tests and interaction contrasts from linear mixed effects models. μS = microsiemens. ^*P < 0.05; ^†P < 0.10.