Researchers at Penn Medicine found evidence that patients and hospital employees alike experience racism and prejudice within health care by analyzing over 90,000 online reviews.
The study was published on Sept. 22 in the Diversity, Equity, and Inclusion issue of JAMA Network Open, an open-access medical journal for biomedical research. Researchers collected 90,786 reviews on the website Yelp published between 2010 and 2020, and they identified 260 reviews that contained instances of racism spanning 190 hospitals in 33 states.
The study also found that the experience of racism was “bidirectional” — meaning health care consumers experienced racism from physicians, nurses, security officers, and reception staff, and vice versa.
In a blog post for the Leonard Davis Institute of Health Economics, first author Jason Tong wrote that it can be difficult to analyze interpersonal racism because there is no "healthcare-specific metric" that researchers can use to study it, making customer reviews a valuable resource.
"Consumer reviews, such as Yelp reviews, may be an untapped resource for examining the presence of racism within health care. Unlike other existing hospital patient surveys, consumer reviews are familiar to the lay community, widely used, and open-ended,” Tong wrote.
He added in the post that the researchers chose Yelp because their reviews are anonymous and independent from the hospitals which encourages honest reports. According to the study, Yelp is also the most widely used referral website in the world and has built-in measures to prevent fake ratings.
For the study, the researchers categorized the Yelp reviews into different domains, including interpersonal racism, institutional racism, and internalized racism; settings, such as clinical and non-clinical; and themes, including “unprofessional,” “acts of omission,” and “incompetence."
The majority of reviews reported interpersonal racism, particularly racism from physicians and nurses. "Disrespect," "unprofessionalism," and "acts of omission" were the most common themes of these experiences with interpersonal racism, the study reads.
Previous Penn Med research has also found similar race-based disparities in patient experiences. A 2020 study by Penn Med found that patients can receive varied treatment for acne by healthcare providers based on factors such as sex, race, or insurance.
In the Penn LDI blog post, Tong called for more concrete ways to measure racism in the hospital setting focusing on both objective, structural racism and subjective experiences of racism.
“These qualitative data can help administrators gauge levels of racism within hospital settings, and direct efforts to improve upon these negative patient experiences to address racial disparities in care,” Tong wrote.