Jessica Isom, MD, MPH, is a board-certified community psychiatrist and Clinical Instructor in the Yale Department of Psychiatry.
Stereotype threat, although it may not be intentional in all cases, however, is a cankerworm that is eating deep into the health system. The entire human race is grouped into different populations; gender, race, age, education level, geography, disability, sexual orientation, etc. There is always the minority and majority under this grouping. Stereotype threats occur when individuals in a specific minority population begin to make negative stereotypes linked with an individual’s status, leading to severe psychological and physiological problems. Health disparities result from poverty, threats from the environment, inadequate access to health care, inequalities in educational statuses, etc. Health disparities are the health differences across a specific population that hinders people’s chance of enjoying optimal healthcare. Health disparities, also referred to as health equity, pose a significant threat against health equality worldwide. Health disparities are preventable and mainly affect socially disadvantaged people- the minority, making this disadvantaged population face worse health outcomes. Stereotype threat is prominent as a result of the interactions between patients and health providers. Usually, health providers create this threat without their intentions. Stereotype health and health disparities are not usually talked about as should be. There are specific facts and information individuals should have to reduce this stereotype threat in society.
How stereotype threat may affect patients’ health
Stereotype threat gradually affects patients’ health, especially the socially disadvantaged and stigmatized identities. It doesn’t affect patients immediately but instead follows a process. This process starts with an awareness of negative stereotypes or reputation within patients. This awareness then leads to unnecessary uncertainty and vigilance, resulting in patients looking for cues to confirm stereotype relevance. Then, patients’ will start using these cues to see themselves in the same light (uncertainty). Patients start seeing themselves as the disadvantaged population, leading to mild or severe physiological and psychological problems. The minority population starts feeling threatened by the unfair and bias treatment from their health care providers, even without experiencing the threat.
The adverse impacts of stereotype threat on the health system
Disengagement/ avoidance of healthcare: When individuals feel threatened by stereotypes, they tend to avoid every situation and events that will remind them of the threat. In this case, if visiting a physician will remind them of the stereotype threat, they would instead not go. They disengage from this kind of situation, which may prevent them from getting the necessary medical attention at the appropriate time. Individuals start missing appointments, and their health conditions may begin to deteriorate.
Adherence to treatment plan: This may occur in three different ways. Firstly, according to research, stereotype threat may reduce cognitive performance and memory capacity, resulting in patients not remembering their treatment plan. In the second case, performance expectation and self-control is lowered by stereotype threat. In this case, patients will have difficulties processing information and will find it challenging to adhere to the treatment plan. Lastly, stereotype threat is associated with decreased effort and may lead to a lack of motivation to stick to the treatment plan.
Misidentification: Sometimes, as a result of an extended stereotype threat, an individual is not able to identify the domain the threat exists. They create a concept that they can relate to personally and decide to identify with this peculiar concept. Such a patient begins to behave to fit into this particular concept and may deprive themselves of living the usual healthy lifestyle they deserve.
Avoiding feedback: When a specific population or domain threatens patients, they tend to downplay or ignore the importance of feedback in groups by which they are threatened. They will ignore the feedback and information that will improve their health because of the stereotype threat.
Reinforcing stereotype: Once patients identify as a particular stigmatized identity/ socially disadvantaged population, they tend to behave accordingly. This situation leads to health care providers treating them the same way and making health decisions by their stereotypes. In this case, the stereotype is reinforced, which may result in health disparities in health outcomes.
Impact of stereotype threat on patient-physician communication: Sometimes, patients may not avoid their health care providers; however, ineffective communication may hinder proper treatment. In individuals suffering from stereotype threat, communication can be affected gravely. For instance, in a situation where the patient sees the caregiver as someone in the majority population, the patient may feel threatened and less comfortable, resulting in a cold and hostile environment. No effective communication could result from a cold environment. Also, stereotype threat leads to impaired cognitive behavior and working memory capacity. Impaired cognitive behavior can affect the communication process and cause ineffective communication. Health caregivers are unable to get essential information that would help give patients better health because of this compromised communication process.
Roles of physicians/hippocrates in reducing stereotype threat
Reducing stereotype threat should be a movement if we want to ensure that everyone gets access to optimal healthcare. As caregivers/physicians, we have tangible roles to play to ensure that society’s stereotype threat is significantly reduced. There are intentional ways and strategies to make this movement possible. There are specific things physicians need to do to foster effective patient-physician communication and relationship with patients possessing stigmatized identities to reduce healthcare disparities/health equity. Some of these ways are;
- Eliminating all forms of prejudice and discrimination by clinical staff and non-clinical staff too.
- Providing clear and easily-understood information, instructions, and descriptions.
- Enlightening clinical staff on giving useful critical feedback to patients and the importance of effective feedback.
- Assisting patients in focusing on their strengths and growth rather than their weaknesses.
- Doing everything within their power to eliminate patients’ anxiety.
- Letting patients know they matter and that they are highly valued.
Health is a vital part of humanity, and everything that poses a threat to achieving our desired health outcomes should be eliminated. Social and economic differences have been proven to cause health disparities/health equity in our society. They could prevent us from achieving our dream of giving optimal health care to everyone that deserves it, irrespective of their social or economic background.
Burgess, D. J., Warren, J., Phelan, S., Dovidio, J., & van Ryn, M. (2010). Stereotype threat and health disparities: what medical educators and future physicians need to know. Journal of general internal medicine, 25 Suppl 2(Suppl 2), S169–S177. https://doi.org/10.1007/s11606-009-1221-4
Patient Orator is launching a mobile health app for the underrepresented people to have their voices heard when speaking to doctors and to eliminate healthcare disparities. Our goal is to establish a patient-physician communication system whereby everyone, regardless of race, social class, ethnic group, or cultural group, can access health equitably. For this, we have designed a stand-alone app that breaks the barriers impairing the quality of patient-physician interaction.
Our app is focused on addressing mistrust among underrepresented groups in their healthcare encounter by bridging the communication gap. With our app, everyone can securely document changes in their health conditions without fear or anxiety caused by stereotype threats in order to, enjoy quality patient-physician interaction, and equal medical representation.
Our mission to bridge the communication gap doesn’t end there. We understand that there has to be a learning and unlearning process to create a change. Therefore, we are continually working with physician advocates and medical professionals to raise a voice for patients across all ethnic, cultural, racial, and age groups.
We conducted a live webinar on October 5th in collaboration with Dr. Jessica Isom, MPH. The webinar featured a panel of physician advocates to dissect and discuss how negative stereotype threats affect health care disparities and how it can affect the patient. The webinar acknowledges the struggles of patients who may have experienced or are experiencing negative stereotype threats and aims to bring awareness to these issues, foster effective interaction between patients and healthcare providers, and ultimately help patients take charge of their health with the Patient Orator app.