{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T02:35:36Z","timestamp":1777430136134,"version":"3.51.4"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T00:00:00Z","timestamp":1660867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000092","name":"National Library of Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000092","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["#1R01LM013301"],"award-info":[{"award-number":["#1R01LM013301"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>People who experience marginalization, including Black, Indigenous, People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender, Queer, Plus (ie, all other marginalized genders and sexual orientations) people (LGBTQ+) experience discrimination during healthcare interactions, which negatively impacts patient\u2013provider communication and care. Yet, scarce research examines the lived experience of unfair treatment among patients from marginalized groups to guide patient-centered tools that improve healthcare equity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We interviewed 25 BIPOC and\/or LGBTQ+ people about their experiences of unfair treatment and discrimination when visiting healthcare providers. Through thematic analysis, we describe participants\u2019 immediate reactions and longer-term consequences of those experiences.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 4 ways that participants reacted to discrimination in the moment: Fighting, Fleeing, Excusing, and Working Around Bias. Long-term consequences reflect 6 ways they coped: Delaying or Avoiding Care, Changing Healthcare Providers, Self-prescribing, Covering Behaviors, Experiencing Health Complications, and Mistrusting Healthcare Institutions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>By describing how patients react to experiences of unfair treatment and discrimination, our findings enhance the understanding of health disparities as patients cope and struggle to speak out.<\/jats:p>\n                  <jats:p>To combat these problems, we identify 3 future directions for informatics interventions that improve provider behavior, support patient advocacy, and address power dynamics in healthcare.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>BIPOC and LGBTQ+ patients\u2019 perspectives on navigating unfair treatment and discrimination in healthcare offers critical insight into their experiences and long-term consequences of those experiences. Understanding the circumstances and consequences of unfair treatment, discrimination, and the impact of bias through this patient-centered lens is crucial to inform informatics technologies that promote health equity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocac142","type":"journal-article","created":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T22:17:58Z","timestamp":1660947478000},"page":"2075-2082","source":"Crossref","is-referenced-by-count":53,"title":["Maybe they had a bad day: how LGBTQ and BIPOC patients react to bias in healthcare and struggle to speak out"],"prefix":"10.1093","volume":"29","author":[{"given":"Calvin","family":"Apodaca","sequence":"first","affiliation":[{"name":"Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington , Seattle, Washington, USA"}]},{"given":"Reggie","family":"Casanova-Perez","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington , Seattle, Washington, USA"}]},{"given":"Emily","family":"Bascom","sequence":"additional","affiliation":[{"name":"Information School, University of Washington , Seattle, Washington, USA"}]},{"given":"Deepthi","family":"Mohanraj","sequence":"additional","affiliation":[{"name":"Department of Biology, University of Washington , Seattle, Washington, USA"}]},{"given":"Cezanne","family":"Lane","sequence":"additional","affiliation":[{"name":"Department of Biology, University of Washington , Seattle, Washington, USA"}]},{"given":"Drishti","family":"Vidyarthi","sequence":"additional","affiliation":[{"name":"Department of Human Centered Design and Engineering, University of Washington , Seattle, Washington, USA"}]},{"given":"Erin","family":"Beneteau","sequence":"additional","affiliation":[{"name":"Information School, University of Washington , Seattle, Washington, USA"}]},{"given":"Janice","family":"Sabin","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington , Seattle, Washington, USA"}]},{"given":"Wanda","family":"Pratt","sequence":"additional","affiliation":[{"name":"Information School, University of Washington , Seattle, Washington, USA"}]},{"given":"Nadir","family":"Weibel","sequence":"additional","affiliation":[{"name":"Department of Computer Science and Engineering, University of California San Diego , La Jolla, California, USA"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4932-7314","authenticated-orcid":false,"given":"Andrea L","family":"Hartzler","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington , Seattle, Washington, USA"}]}],"member":"286","published-online":{"date-parts":[[2022,8,19]]},"reference":[{"key":"2022111607595240800_ocac142-B1","first-page":"13128","volume-title":"The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding, Vol.","author":"Graham","year":"2011"},{"issue":"1","key":"2022111607595240800_ocac142-B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12910-017-0179-8","article-title":"Implicit bias in healthcare professionals: a systematic review","volume":"18","author":"FitzGerald","year":"2017","journal-title":"BMC Med Ethics"},{"issue":"12","key":"2022111607595240800_ocac142-B3","doi-asserted-by":"crossref","first-page":"e60","DOI":"10.2105\/AJPH.2015.302903","article-title":"Implicit racial\/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review","volume":"105","author":"Hall","year":"2015","journal-title":"Am J Public Health"},{"issue":"220 Suppl 2","key":"2022111607595240800_ocac142-B4","doi-asserted-by":"crossref","first-page":"S62","DOI":"10.1093\/infdis\/jiz214","article-title":"The impact of unconscious bias in healthcare: how to recognize and mitigate it","volume":"220","author":"Marcelin","year":"2019","journal-title":"J Infect Dis"},{"key":"2022111607595240800_ocac142-B5","volume-title":"Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. 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