Purpose: Racial disparities in health care utilization are well-documented. One potential cause of these disparities is perceived discrimination in the healthcare setting. Whether perceptions of past discrimination impact patients' future healthcare experiences, however, has not been studied. Therefore, in a sample of African American patients seeking treatment for advanced osteoarthritis, we examined the relationship between past experiences of racial discrimination in healthcare and satisfaction with treatment recommendations.

Methods: This analysis included 38 African American patients (95% male) from a larger study of patients who consulted with orthopedic surgeons for treatment of chronic knee/hip pain at the Pittsburgh and Cleveland VA medical centers. Prior to the consultation, patients indicated how often they had experienced 7 forms of racial discrimination while seeking healthcare (e.g., received poorer services). Response options ranged from 1 (Never) to 5 (Always). Responses were averaged across the seven items and then categorized into 3 ordinal groups from those who perceived no discrimination to those scoring above the 75th percentile. Following the consultation, patient satisfaction with the surgeon's treatment recommendation was assessed using the 6-item Satisfaction with Health Care Decision Scale. Responses were averaged across items, with possible scores ranging from 1 to 5 and higher scores indicating more satisfaction. Given the non-normality of satisfaction scores, the association between increasing levels of perceived discrimination and satisfaction was assessed using a non-parametric test for trend.

Results: Most (61%) patients reported experiencing at least some form of racial discrimination while seeking healthcare. However, average perceived discrimination was low (Median = 1.71, IQR = 1 – 2.71). Although satisfaction with the treatment recommendation was generally high (Median = 4, IQR = 4-4.5), the non-parametric test for trend revealed a negative relationship between perceived discrimination and patient satisfaction (p = .03). Patients who perceived more past racial discrimination while seeking healthcare reported less satisfaction with their current treatment recommendation.

Conclusions: This is the first study to examine whether patients' perceptions of past discrimination can shape subsequent encounters with the healthcare system. Among African American patients receiving orthopedic consultation for chronic knee/hip pain, those who reported more past experiences with racial discrimination while seeking healthcare reported less satisfaction with treatment recommendations. Perceived discrimination in healthcare might play a role in racial disparities in health care utilization and outcomes.