Patient race and perceived illness responsibility: Effects on provider helping and bias

Abstract

Objectives: Health care disparities represent a major issue impacting the quality of care in the USA. Provider biases have been identified as contributing to health care disparities. This study examined the helping intentions and biases reported by medical students based on patient race and perceived patient responsibility. The study was guided by the responsibility-affect-helping model (RAHM), which proposes that helping behaviour is a function of perceived responsibility and affect. Methods: In a 2 × 3 online experiment, medical students (n = 231) viewed a health chart and dialogue for either a Black or a White patient, in which the dialogue included a manipulation of the patient's rationales for his non-compliance with diet recommendations (responsible, not responsible, no responsibility assigned). After viewing the manipulation, medical students completed measures regarding perceived patient responsibility, affect, intention to help, perceptions of the patient and ethnocentrism. Results: The RAHM was supported, such that increased perceived patient responsibility led to increased provider anger and reduced provider helping intentions, whereas decreased perceived patient responsibility led to increased provider empathy and helping intentions. Additionally, an interaction effect between race and perceived patient responsibility occurred such that bias toward the Black patient was most likely to occur in the control condition. Conclusions: Perceived patient responsibility affects provider helping intentions and interacts with patient race to influence provider perceptions of patient characteristics. Communication on rationales for non-compliance as associated with perceived responsibility may lead to better or worse patient care as providers make attributions about patients based on these factors. © 2013 John Wiley & Sons Ltd.