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Black Men’s Patient–Clinician Experiences: Pathways to Enhanced Healthcare Outcomes in the United States

PMCID: PMC12154956

PMID:

Abstract

Background/Objectives : The persistent health disparities affecting Black men in the US healthcare system reflect systemic inequities that impact their health outcomes. This qualitative study employs thematic analysis to examine how Black men’s interactions with medical providers shape their healthcare experiences and to identify key factors influencing their quality of care. Methods : Through in-depth interviews with 25 Black men throughout the United States, our thematic analysis identified patterns in their reported healthcare experiences. Results : Our analysis revealed four main themes: (1) inadequate clinician communication and information, (2) clinician dismissiveness and failure to listen, (3) experiences of interpersonal racial bias in healthcare interactions, and (4) facilitators of positive, patient-centered healthcare encounters. Black men’s narratives illuminate how communication barriers, dismissive treatment, and racial bias manifest in healthcare settings, while also highlighting elements that facilitate successful patient–clinician relationships. Conclusions : The findings suggest specific approaches for improving these interactions, including clinician active listening and bias training, anti-racism medical education, accountability policies, increased clinician diversity, and patient self-advocacy strategies to address systemic factors affecting Black men’s healthcare experiences and outcomes.

Full Text

Significant health disparities persist for Black men in the United States despite decades of research. A recent longitudinal study has documented alarming statistics, with the Black population experiencing more than 1.63 million excess deaths and over 80 million excess years of life lost compared to the White population from 1999 to 2020 [1]. These disparities are particularly concerning for Black men, who face lower average life expectancy and higher rates of chronic conditions compared to White men [2]. The disparate health outcomes for Black men are well documented. For instance, 42% of Black men have hypertension compared to 31% of White men [3], and they have higher risks for kidney disease and diabetes complications [2,4].
These disparities affect Black men’s physical health as well as the biological aging processes. Research examining biological aging has found evidence that Black Americans experience accelerated “weathering”, a concept developed by Geronimus and colleagues [5] to describe premature aging and health deterioration resulting from chronic exposure to social and economic adversity and political marginalization. A 2018 study finds Black Americans’ biological age averages 2.6 years older than their chronological age, while White Americans’ biological age averages 3.5 years younger than their chronological age, representing a 6.1-year weathering differential between the groups [6]. This weathering effect is amplified by lower socioeconomic status and increased depressive symptoms, which have stronger associations with accelerated aging among Blacks than Whites [6].
Health disparities cannot be attributed to healthcare utilization alone. Recent evidence contradicts stereotypes about Black men’s failure to use healthcare services, showing that they are active users of health services, and they strive to remain healthy for themselves and their families [7]. Additionally, research has found that Black men were more likely to participate in various preventive screenings, including physical examinations, dental check-ups, eye examinations, blood pressure and cholesterol screenings, and cancer screenings, than White men [8]. This evidence challenges stereotypical assumptions about healthcare avoidance among Black men and suggests that barriers to optimal health outcomes extend beyond the issue of healthcare engagement.
Furthermore, Black men’s health disparities persist across socioeconomic strata. Even at equivalent levels of income or education, Black Americans consistently experience worse health outcomes than White Americans [9]. Research indicates that while higher education typically protects Black men from depressive symptoms, Black men who have only completed high school may have a higher risk of depression over time [10]. These findings suggest that social factors beyond traditional socioeconomic variables significantly influence Black men’s health outcomes.
The Institute of Medicine, now known as the National Academy of Medicine (NAM) [11], has acknowledged that even after accounting for socioeconomic differences, race and ethnicity remain significant predictors of disparities in healthcare. The pervasive nature of these disparities points to underlying systemic factors, such as systemic racism, which is a foundational and pervasive system of oppression embedded in all major societal institutions. Systemic racism extends beyond individual prejudice, encompassing centuries-old patterns that subordinate people of color, causing unfair disadvantages [12], such as structured inequalities in resources, power, and opportunity [13]. Systemic racism operates at both social and structural levels, affecting how Black men are perceived and treated within healthcare settings and limiting their access to healthy food, safe neighborhoods, educational and professional opportunities, and quality healthcare [2]. Racism is now widely recognized as a fundamental cause of adverse health outcomes for Black Americans [14].
Medical mistreatment—rooted in systemic racism—has created a deep-rooted mistrust of the healthcare system among many Black men in the United States. This mistrust stems from a history of reproductive exploitation during slavery, the eugenics movements, stereotypes and pseudoscience about Black men’s bodies and sexuality, and a host of medical experimentations—notably the Tuskegee Syphilis Study [15,16,17]. This historical foundation of mistrust continues to influence contemporary healthcare interactions, with research consistently showing that Black patients report lower trust in their physicians than White patients [18,19,20,21,22].
Black men’s lack of trust in healthcare relationships is exacerbated by problematic patient–clinician communication patterns. During clinical encounters with Black patients, physicians have been found to use fewer statements that build rapport and connection, conduct shorter visits, speak more rapidly, and display greater verbal dominance compared to their interactions with White patients [18]. These communication disparities correlate with Black men’s reduced trust and may potentially contribute to the lower rates of healthcare utilization observed among some Black men [11,23,24,25,26,27,28].
Evidence of bias within healthcare settings extends beyond interpersonal interactions to documentation practices. Recent research has found that Black patients had 2.54 times the odds of being described with negative descriptors in their electronic health records compared to White patients, even after adjusting for sociodemographic and health characteristics [29]. These disparities raise concerns about racial bias and the potential transmission of stigma through medical records.
Recent research suggests that media stereotypes often shape healthcare professionals’ perceptions of Black men as “violent, scary, and unreliable”, and these assumptions can affect diagnosis and treatment decisions, including withholding certain procedures or assuming medical non-compliance [30]. In racially discordant medical interactions, non-Black physicians with higher levels of implicit racial bias have been observed using more words reflecting social dominance, such as authoritative statements like “We need to make sure that you take your medicine”, and displaying greater anxiety when interacting with Black patients [31].
Implicit biases among healthcare professionals have tangible effects on patient care. A systematic review found that healthcare professionals’ implicit biases were significantly related to patient–clinician interactions, treatment decisions, treatment adherence, and patient health outcomes [32]. A 2016 study found a substantial number of medical students and residents continue to hold false beliefs about biological differences between Blacks and Whites—myths that have historically been used to justify racial oppression. These persistent misconceptions predict racial bias in pain perception and treatment recommendation accuracy, demonstrating how historical race-based pseudoscience continues to influence modern medical practice [33].
The health effects of discrimination extend beyond direct interactions with healthcare providers. Research has associated perceived discrimination with negative physiological responses in Black Americans, including elevated blood pressure that persists during sleep (when it should naturally decrease) and poorer sleep quality with reduced deep sleep compared to White Americans [34,35,36]. These findings support the argument that discrimination significantly contributes to racial differences in important indicators of poor health and disease [37].
Despite ample evidence of systemic bias in the US healthcare system, resistance to addressing it remains. Recent studies with medical students find widespread denial that personal bias can influence clinical outcomes [38]. This resistance highlights the challenges in implementing effective interventions to address healthcare disparities.
The literature clearly establishes that Black men face significant health disparities influenced by systemic factors, historical and ongoing discrimination, and problematic patterns of healthcare interaction. However, relatively few studies have explored Black men’s lived experiences of healthcare encounters from their own perspectives. While survey data from the Pew Research Center indicates that many Black adults report at least one negative interaction with healthcare providers [39], there remains a need for more in-depth qualitative explorations of how Black men navigate and experience healthcare relationships.
Texas Southern University’s Institutional Review Board (IRB) provided approval for this research. To capture the depth and complexity of Black men’s healthcare experiences, we employed a qualitative study design using in-depth interviews. This approach allowed for a detailed exploration of participants’ lived experiences [40]. Eligibility criteria for study participation included self-identification as Black or African American, male, at least 18 years of age, and residence within the United States. The first and third authors used purposive sampling techniques to recruit 25 participants through professional social media channels like LinkedIn and community referral networks. Of approximately 300 Black men who received invitations to participate in the study, about 150 responded to the initial recruitment advertisement; around 75 respondents were subsequently excluded for not meeting inclusion criteria (such as not residing in the United States), while others discontinued participation of their own volition, resulting in our final sample of 25 participants. Participants engaged in the study only after providing written and verbal informed consent, which detailed study objectives, confidentiality protections, and their right to discontinue participation without consequences. Participants received a USD 50 gift card in acknowledgment of their time and insights.
The analytical process followed Braun and Clarke’s six-phase thematic analysis framework [41]. We implemented this methodology through a systematic process beginning with data familiarization through repeated readings of transcripts; developing initial codes inductively from participants’ language rather than predetermined categories; generating preliminary themes by identifying patterns across codes; refining themes through iterative comparison with the dataset; defining and naming themes to capture their essence and relationships; and, finally, producing the analytical report. An independent qualitative methodologist and the first author conducted analyses of the data. Initial coding was performed independently on all transcripts using an open coding approach where codes emerged directly from participants’ experiences rather than predetermined frameworks. The process began with multiple careful readings of each transcript, followed by systematic line-by-line coding to identify meaningful segments related to healthcare experiences. The codes were compared, and minor discrepancies were resolved through discussion to develop a comprehensive coding framework. The qualitative software NVivo (version 14) was used to facilitate the organization and coding of the data. The codes were then organized into potential themes and subthemes based on patterns of meaning. This process included searching for negative cases that contradicted emerging patterns and revising thematic boundaries to accommodate the full range of participant experiences. The second and third authors then evaluated these preliminary themes for consistency with participant narratives, theoretical relevance, and internal coherence. Final themes emerged through iterative refinement until reaching theoretical saturation, which is the point at which additional analysis yielded no new thematic elements.
This qualitative study included 25 Black male participants with diverse demographic characteristics. The sample consisted of adults primarily aged 30–39 (41.2%) and 18–29 (35.3%), with the majority (82.4%) living in the South. Most participants were highly educated, with 47.1% holding master’s degrees and 11.8% with doctorate degrees. In terms of income, the largest proportion of participants (47.1%) earned between USD 60,000 and USD 99,999 annually. Most participants were employed, with 58.8% working full-time (40 or more hours weekly) and 35.3% working part-time. It should be noted that approximately one-third of participants had missing demographic data; these cases were excluded from percentage calculations to provide a more accurate representation of the reported demographics (Table 1).
Through thematic analysis of in-depth interview data, we identified four predominant themes reflecting participants’ healthcare experiences with medical providers: (1) inadequate clinician communication and information—participants described receiving insufficient explanations about medical conditions and treatment options; (2) clinician dismissiveness and failure to listen—men recounted instances where medical concerns were minimized or disregarded; (3) experiences of interpersonal racial bias in healthcare interactions—participants reported experiencing differential treatment based on racial identity; and (4) facilitators of positive, patient-centered healthcare encounters—men highlighted elements that enhanced their healthcare interactions, including respectful communication and cultural awareness. Table 2 provides illustrative quotes for each theme.
This study explored Black men’s interactions with clinicians, revealing three themes that negatively affected their care experiences: inadequate clinician communication, dismissive attitudes, and interpersonal racial bias. These findings illuminate the complex dynamics undermining healthcare quality for Black men, which can contribute to persistent health disparities. Participants also identified a fourth theme—facilitators of positive, patient-centered healthcare encounters—which provides valuable direction for improving care delivery. Our findings align with and extend the existing literature on healthcare disparities affecting Black men. The inadequate communication and dismissiveness themes parallel research by Martin et al. [18], who found physicians use fewer rapport-building statements with Black patients, resulting in shorter visits and reduced trust. Communication breakdown directly impacts health outcomes through decreased medication adherence [42,43], delayed follow-up care [44], and fragmented healthcare experiences. Similarly, participants’ experiences of dismissiveness, particularly regarding pain and symptoms, connect to documented patterns of provider behavior that contribute to diagnostic delays and inappropriate treatment plans [33,45]. These experiences reflect broader patterns of implicit bias in healthcare, where providers’ unconscious biases influence clinical decision-making [32], creating systemic barriers to equitable care. Hoffman et al. [33] demonstrated how false beliefs about biological differences contribute to racial bias in pain perception and treatment recommendations, directly impacting the pain management experiences described by our participants with conditions like sickle cell disease. Conversely, the positive experiences identified in our study align with research showing that race-concordant care and patient-centered approaches lead to improved health outcomes, such as higher life expectancy [46]. These connections between patient–clinician interactions and health outcomes underscore the critical importance of addressing interpersonal and systemic factors in healthcare delivery for Black men.
Overall, the findings illustrate how interpersonal clinical interactions can reflect and perpetuate broader patterns of structural racism within healthcare delivery systems, contributing to experiences that shape Black men’s access to quality care [13,47]. The communication barriers, dismissive treatment, and racial bias Black men encounter are not random events but consistent patterns that reveal how structural inequities in healthcare directly affect their lived experiences. When healthcare professionals minimize symptoms, rush appointments, or make biased assumptions, they reinforce institutional practices that limit Black men’s access to comprehensive diagnostics, appropriate pain management, and consistent care—directly contributing to documented disparities in chronic disease [2,4], preventive screening utilization [8], and mortality rates [1]. By understanding these patient–clinician interactions as expressions of structural factors rather than individual failings, we can develop more effective interventions that address both the interpersonal dynamics and the underlying systems that perpetuate health inequities for Black men.
Clinicians can enhance patient-centered communication with Black men by prioritizing active listening, which is considered the most effective form of listening [48,49] and entails “avoiding interruption, maintaining interest, postponing evaluation, organizing information, and showing interest” [48]. Active listening could help clinicians understand their Black patients’ needs, fostering better communication and building essential trust. Practical applications include scheduling brief follow-up contacts between visits, creating collaborative care plans that incorporate patient priorities, and including verified treatment barriers reported by patients, even if briefly, in their notes. Within ethical and legal boundaries, clinicians may also consider implementing adherence programs that include non-financial incentives to promote patient treatment and follow-up care. Clinicians should also allocate sufficient time for appointments with Black men, ensuring thorough explanations of diagnoses, treatment options, and follow-up care. As our participants noted, rushed appointments significantly undermined trust and satisfaction with care. Implementing communication techniques that emphasize partnership rather than authority [31] could help establish more equitable relationships. Clinicians could benefit from annual continuing education courses that enhance communication skills with diverse patients. Regular self-assessment through instruments like the Implicit Association Test (IAT) can help clinicians identify and address biases that may influence their clinical decisions [50].
Medical education should integrate anti-racism training throughout curricula, rather than as isolated modules. This training should directly address the false beliefs about biological differences between races [33] and explain how historical misconceptions about race continue to influence modern practice and contribute to disparities in pain management and treatment recommendations. Medical education should incorporate the lived experiences of Black patients through case studies and patient narratives. For example, participants’ accounts of clinician microaggressions—brief verbal or non-verbal disparagements [51,52,53], including dismissiveness, biased assumptions, and inappropriate jokes—should be integrated into medical training. Exposing students to these experiences and their impact on patient trust and care continuity may enhance empathy and foster cultural humility.
Healthcare policy should mandate accountability measures to address racial disparities in care quality. State policymakers should require healthcare institutions to implement standardized bias and discrimination reporting systems with data submitted to a central repository. Such systems could be modeled after the Bias Reporting Tool (BRT) developed by UW Medicine in Seattle, Washington [54]. These systems should include clear evaluation metrics, including analysis of reported incidents and patient satisfaction surveys, to measure progress. Implementing this approach across states would enable the identification of systemic patterns requiring targeted intervention. Policymakers should also establish targeted funding streams and incentive programs to increase racial diversity among clinicians, which would expand patient access to race-concordant care. To address retention and prevent burnout of clinicians of color, policymakers should create financial incentives for healthcare institutions that implement peer support networks, provide dedicated mental health resources, ensure reasonable workload distributions, and create “safe space” groups where professionals of color can share experiences and strategies for navigating workplace challenges. These initiatives should also support the recruitment of Black healthcare professionals through structured mentorship opportunities and protected time for community engagement initiatives. This recommendation is supported by our finding that participants actively sought race-concordant care and is consistent with research demonstrating how racial concordance improves patient trust and adherence to treatment recommendations [55].
Equipping Black men with effective self-advocacy strategies is essential for navigating potentially dismissive or biased healthcare encounters. Healthcare organizations should partner with trusted community centers and churches to develop and distribute culturally relevant self-advocacy resources to Black men and train health workers who can connect clinical care to their everyday experiences. Self-advocacy resources, such as question guides, patient rights information, and approaches for seeking second opinions, can empower Black men to secure thorough examinations, clear explanations, and appropriate care. Recent research underscores the value of these approaches, showing that patient self-advocacy can reduce the impact of physicians’ implicit biases [56], making these tools particularly valuable for Black men seeking equitable healthcare. Patient advocacy organizations should collaborate with healthcare institutions to establish patient advisory boards with significant representation from Black men. These boards could provide input on policies, procedures, and communication practices to ensure they address the concerns highlighted in our study.

Sections

"[{\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B1-healthcare-13-01230\", \"B2-healthcare-13-01230\", \"B3-healthcare-13-01230\", \"B2-healthcare-13-01230\", \"B4-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"Significant health disparities persist for Black men in the United States despite decades of research. A recent longitudinal study has documented alarming statistics, with the Black population experiencing more than 1.63 million excess deaths and over 80 million excess years of life lost compared to the White population from 1999 to 2020 [1]. These disparities are particularly concerning for Black men, who face lower average life expectancy and higher rates of chronic conditions compared to White men [2]. The disparate health outcomes for Black men are well documented. For instance, 42% of Black men have hypertension compared to 31% of White men [3], and they have higher risks for kidney disease and diabetes complications [2,4].\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B5-healthcare-13-01230\", \"B6-healthcare-13-01230\", \"B6-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"These disparities affect Black men\\u2019s physical health as well as the biological aging processes. Research examining biological aging has found evidence that Black Americans experience accelerated \\u201cweathering\\u201d, a concept developed by Geronimus and colleagues [5] to describe premature aging and health deterioration resulting from chronic exposure to social and economic adversity and political marginalization. A 2018 study finds Black Americans\\u2019 biological age averages 2.6 years older than their chronological age, while White Americans\\u2019 biological age averages 3.5 years younger than their chronological age, representing a 6.1-year weathering differential between the groups [6]. This weathering effect is amplified by lower socioeconomic status and increased depressive symptoms, which have stronger associations with accelerated aging among Blacks than Whites [6].\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B7-healthcare-13-01230\", \"B8-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"Health disparities cannot be attributed to healthcare utilization alone. Recent evidence contradicts stereotypes about Black men\\u2019s failure to use healthcare services, showing that they are active users of health services, and they strive to remain healthy for themselves and their families [7]. Additionally, research has found that Black men were more likely to participate in various preventive screenings, including physical examinations, dental check-ups, eye examinations, blood pressure and cholesterol screenings, and cancer screenings, than White men [8]. This evidence challenges stereotypical assumptions about healthcare avoidance among Black men and suggests that barriers to optimal health outcomes extend beyond the issue of healthcare engagement.\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B9-healthcare-13-01230\", \"B10-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"Furthermore, Black men\\u2019s health disparities persist across socioeconomic strata. Even at equivalent levels of income or education, Black Americans consistently experience worse health outcomes than White Americans [9]. Research indicates that while higher education typically protects Black men from depressive symptoms, Black men who have only completed high school may have a higher risk of depression over time [10]. These findings suggest that social factors beyond traditional socioeconomic variables significantly influence Black men\\u2019s health outcomes.\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B11-healthcare-13-01230\", \"B12-healthcare-13-01230\", \"B13-healthcare-13-01230\", \"B2-healthcare-13-01230\", \"B14-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"The Institute of Medicine, now known as the National Academy of Medicine (NAM) [11], has acknowledged that even after accounting for socioeconomic differences, race and ethnicity remain significant predictors of disparities in healthcare. The pervasive nature of these disparities points to underlying systemic factors, such as systemic racism, which is a foundational and pervasive system of oppression embedded in all major societal institutions. Systemic racism extends beyond individual prejudice, encompassing centuries-old patterns that subordinate people of color, causing unfair disadvantages [12], such as structured inequalities in resources, power, and opportunity [13]. Systemic racism operates at both social and structural levels, affecting how Black men are perceived and treated within healthcare settings and limiting their access to healthy food, safe neighborhoods, educational and professional opportunities, and quality healthcare [2]. Racism is now widely recognized as a fundamental cause of adverse health outcomes for Black Americans [14].\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B15-healthcare-13-01230\", \"B16-healthcare-13-01230\", \"B17-healthcare-13-01230\", \"B18-healthcare-13-01230\", \"B19-healthcare-13-01230\", \"B20-healthcare-13-01230\", \"B21-healthcare-13-01230\", \"B22-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"Medical mistreatment\\u2014rooted in systemic racism\\u2014has created a deep-rooted mistrust of the healthcare system among many Black men in the United States. This mistrust stems from a history of reproductive exploitation during slavery, the eugenics movements, stereotypes and pseudoscience about Black men\\u2019s bodies and sexuality, and a host of medical experimentations\\u2014notably the Tuskegee Syphilis Study [15,16,17]. This historical foundation of mistrust continues to influence contemporary healthcare interactions, with research consistently showing that Black patients report lower trust in their physicians than White patients [18,19,20,21,22].\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B18-healthcare-13-01230\", \"B11-healthcare-13-01230\", \"B23-healthcare-13-01230\", \"B24-healthcare-13-01230\", \"B25-healthcare-13-01230\", \"B26-healthcare-13-01230\", \"B27-healthcare-13-01230\", \"B28-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"Black men\\u2019s lack of trust in healthcare relationships is exacerbated by problematic patient\\u2013clinician communication patterns. During clinical encounters with Black patients, physicians have been found to use fewer statements that build rapport and connection, conduct shorter visits, speak more rapidly, and display greater verbal dominance compared to their interactions with White patients [18]. These communication disparities correlate with Black men\\u2019s reduced trust and may potentially contribute to the lower rates of healthcare utilization observed among some Black men [11,23,24,25,26,27,28].\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B29-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"Evidence of bias within healthcare settings extends beyond interpersonal interactions to documentation practices. Recent research has found that Black patients had 2.54 times the odds of being described with negative descriptors in their electronic health records compared to White patients, even after adjusting for sociodemographic and health characteristics [29]. These disparities raise concerns about racial bias and the potential transmission of stigma through medical records.\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B30-healthcare-13-01230\", \"B31-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"Recent research suggests that media stereotypes often shape healthcare professionals\\u2019 perceptions of Black men as \\u201cviolent, scary, and unreliable\\u201d, and these assumptions can affect diagnosis and treatment decisions, including withholding certain procedures or assuming medical non-compliance [30]. In racially discordant medical interactions, non-Black physicians with higher levels of implicit racial bias have been observed using more words reflecting social dominance, such as authoritative statements like \\u201cWe need to make sure that you take your medicine\\u201d, and displaying greater anxiety when interacting with Black patients [31].\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B32-healthcare-13-01230\", \"B33-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"Implicit biases among healthcare professionals have tangible effects on patient care. A systematic review found that healthcare professionals\\u2019 implicit biases were significantly related to patient\\u2013clinician interactions, treatment decisions, treatment adherence, and patient health outcomes [32]. A 2016 study found a substantial number of medical students and residents continue to hold false beliefs about biological differences between Blacks and Whites\\u2014myths that have historically been used to justify racial oppression. These persistent misconceptions predict racial bias in pain perception and treatment recommendation accuracy, demonstrating how historical race-based pseudoscience continues to influence modern medical practice [33].\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B34-healthcare-13-01230\", \"B35-healthcare-13-01230\", \"B36-healthcare-13-01230\", \"B37-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"The health effects of discrimination extend beyond direct interactions with healthcare providers. Research has associated perceived discrimination with negative physiological responses in Black Americans, including elevated blood pressure that persists during sleep (when it should naturally decrease) and poorer sleep quality with reduced deep sleep compared to White Americans [34,35,36]. These findings support the argument that discrimination significantly contributes to racial differences in important indicators of poor health and disease [37].\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B38-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"Despite ample evidence of systemic bias in the US healthcare system, resistance to addressing it remains. Recent studies with medical students find widespread denial that personal bias can influence clinical outcomes [38]. This resistance highlights the challenges in implementing effective interventions to address healthcare disparities.\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B39-healthcare-13-01230\"], \"section\": \"1. Introduction\", \"text\": \"The literature clearly establishes that Black men face significant health disparities influenced by systemic factors, historical and ongoing discrimination, and problematic patterns of healthcare interaction. However, relatively few studies have explored Black men\\u2019s lived experiences of healthcare encounters from their own perspectives. While survey data from the Pew Research Center indicates that many Black adults report at least one negative interaction with healthcare providers [39], there remains a need for more in-depth qualitative explorations of how Black men navigate and experience healthcare relationships.\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B40-healthcare-13-01230\"], \"section\": \"2.1. Study Design and Participants\", \"text\": \"Texas Southern University\\u2019s Institutional Review Board (IRB) provided approval for this research. To capture the depth and complexity of Black men\\u2019s healthcare experiences, we employed a qualitative study design using in-depth interviews. This approach allowed for a detailed exploration of participants\\u2019 lived experiences [40]. Eligibility criteria for study participation included self-identification as Black or African American, male, at least 18 years of age, and residence within the United States. The first and third authors used purposive sampling techniques to recruit 25 participants through professional social media channels like LinkedIn and community referral networks. Of approximately 300 Black men who received invitations to participate in the study, about 150 responded to the initial recruitment advertisement; around 75 respondents were subsequently excluded for not meeting inclusion criteria (such as not residing in the United States), while others discontinued participation of their own volition, resulting in our final sample of 25 participants. Participants engaged in the study only after providing written and verbal informed consent, which detailed study objectives, confidentiality protections, and their right to discontinue participation without consequences. Participants received a USD 50 gift card in acknowledgment of their time and insights.\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B41-healthcare-13-01230\"], \"section\": \"2.4. Data Analysis\", \"text\": \"The analytical process followed Braun and Clarke\\u2019s six-phase thematic analysis framework [41]. We implemented this methodology through a systematic process beginning with data familiarization through repeated readings of transcripts; developing initial codes inductively from participants\\u2019 language rather than predetermined categories; generating preliminary themes by identifying patterns across codes; refining themes through iterative comparison with the dataset; defining and naming themes to capture their essence and relationships; and, finally, producing the analytical report. An independent qualitative methodologist and the first author conducted analyses of the data. Initial coding was performed independently on all transcripts using an open coding approach where codes emerged directly from participants\\u2019 experiences rather than predetermined frameworks. The process began with multiple careful readings of each transcript, followed by systematic line-by-line coding to identify meaningful segments related to healthcare experiences. The codes were compared, and minor discrepancies were resolved through discussion to develop a comprehensive coding framework. The qualitative software NVivo (version 14) was used to facilitate the organization and coding of the data. The codes were then organized into potential themes and subthemes based on patterns of meaning. This process included searching for negative cases that contradicted emerging patterns and revising thematic boundaries to accommodate the full range of participant experiences. The second and third authors then evaluated these preliminary themes for consistency with participant narratives, theoretical relevance, and internal coherence. Final themes emerged through iterative refinement until reaching theoretical saturation, which is the point at which additional analysis yielded no new thematic elements.\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"healthcare-13-01230-t001\"], \"section\": \"3.1. Participant Characteristics\", \"text\": \"This qualitative study included 25 Black male participants with diverse demographic characteristics. The sample consisted of adults primarily aged 30\\u201339 (41.2%) and 18\\u201329 (35.3%), with the majority (82.4%) living in the South. Most participants were highly educated, with 47.1% holding master\\u2019s degrees and 11.8% with doctorate degrees. In terms of income, the largest proportion of participants (47.1%) earned between USD 60,000 and USD 99,999 annually. Most participants were employed, with 58.8% working full-time (40 or more hours weekly) and 35.3% working part-time. It should be noted that approximately one-third of participants had missing demographic data; these cases were excluded from percentage calculations to provide a more accurate representation of the reported demographics (Table 1).\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"healthcare-13-01230-t002\"], \"section\": \"3.2. Themes and Representative Quotes\", \"text\": \"Through thematic analysis of in-depth interview data, we identified four predominant themes reflecting participants\\u2019 healthcare experiences with medical providers: (1) inadequate clinician communication and information\\u2014participants described receiving insufficient explanations about medical conditions and treatment options; (2) clinician dismissiveness and failure to listen\\u2014men recounted instances where medical concerns were minimized or disregarded; (3) experiences of interpersonal racial bias in healthcare interactions\\u2014participants reported experiencing differential treatment based on racial identity; and (4) facilitators of positive, patient-centered healthcare encounters\\u2014men highlighted elements that enhanced their healthcare interactions, including respectful communication and cultural awareness. Table 2 provides illustrative quotes for each theme.\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B18-healthcare-13-01230\", \"B42-healthcare-13-01230\", \"B43-healthcare-13-01230\", \"B44-healthcare-13-01230\", \"B33-healthcare-13-01230\", \"B45-healthcare-13-01230\", \"B32-healthcare-13-01230\", \"B33-healthcare-13-01230\", \"B46-healthcare-13-01230\"], \"section\": \"4. Discussion\", \"text\": \"This study explored Black men\\u2019s interactions with clinicians, revealing three themes that negatively affected their care experiences: inadequate clinician communication, dismissive attitudes, and interpersonal racial bias. These findings illuminate the complex dynamics undermining healthcare quality for Black men, which can contribute to persistent health disparities. Participants also identified a fourth theme\\u2014facilitators of positive, patient-centered healthcare encounters\\u2014which provides valuable direction for improving care delivery. Our findings align with and extend the existing literature on healthcare disparities affecting Black men. The inadequate communication and dismissiveness themes parallel research by Martin et al. [18], who found physicians use fewer rapport-building statements with Black patients, resulting in shorter visits and reduced trust. Communication breakdown directly impacts health outcomes through decreased medication adherence [42,43], delayed follow-up care [44], and fragmented healthcare experiences. Similarly, participants\\u2019 experiences of dismissiveness, particularly regarding pain and symptoms, connect to documented patterns of provider behavior that contribute to diagnostic delays and inappropriate treatment plans [33,45]. These experiences reflect broader patterns of implicit bias in healthcare, where providers\\u2019 unconscious biases influence clinical decision-making [32], creating systemic barriers to equitable care. Hoffman et al. [33] demonstrated how false beliefs about biological differences contribute to racial bias in pain perception and treatment recommendations, directly impacting the pain management experiences described by our participants with conditions like sickle cell disease. Conversely, the positive experiences identified in our study align with research showing that race-concordant care and patient-centered approaches lead to improved health outcomes, such as higher life expectancy [46]. These connections between patient\\u2013clinician interactions and health outcomes underscore the critical importance of addressing interpersonal and systemic factors in healthcare delivery for Black men.\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B13-healthcare-13-01230\", \"B47-healthcare-13-01230\", \"B2-healthcare-13-01230\", \"B4-healthcare-13-01230\", \"B8-healthcare-13-01230\", \"B1-healthcare-13-01230\"], \"section\": \"4. Discussion\", \"text\": \"Overall, the findings illustrate how interpersonal clinical interactions can reflect and perpetuate broader patterns of structural racism within healthcare delivery systems, contributing to experiences that shape Black men\\u2019s access to quality care [13,47]. The communication barriers, dismissive treatment, and racial bias Black men encounter are not random events but consistent patterns that reveal how structural inequities in healthcare directly affect their lived experiences. When healthcare professionals minimize symptoms, rush appointments, or make biased assumptions, they reinforce institutional practices that limit Black men\\u2019s access to comprehensive diagnostics, appropriate pain management, and consistent care\\u2014directly contributing to documented disparities in chronic disease [2,4], preventive screening utilization [8], and mortality rates [1]. By understanding these patient\\u2013clinician interactions as expressions of structural factors rather than individual failings, we can develop more effective interventions that address both the interpersonal dynamics and the underlying systems that perpetuate health inequities for Black men.\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B48-healthcare-13-01230\", \"B49-healthcare-13-01230\", \"B48-healthcare-13-01230\", \"B31-healthcare-13-01230\", \"B50-healthcare-13-01230\"], \"section\": \"4. Discussion\", \"text\": \"Clinicians can enhance patient-centered communication with Black men by prioritizing active listening, which is considered the most effective form of listening [48,49] and entails \\u201cavoiding interruption, maintaining interest, postponing evaluation, organizing information, and showing interest\\u201d [48]. Active listening could help clinicians understand their Black patients\\u2019 needs, fostering better communication and building essential trust. Practical applications include scheduling brief follow-up contacts between visits, creating collaborative care plans that incorporate patient priorities, and including verified treatment barriers reported by patients, even if briefly, in their notes. Within ethical and legal boundaries, clinicians may also consider implementing adherence programs that include non-financial incentives to promote patient treatment and follow-up care. Clinicians should also allocate sufficient time for appointments with Black men, ensuring thorough explanations of diagnoses, treatment options, and follow-up care. As our participants noted, rushed appointments significantly undermined trust and satisfaction with care. Implementing communication techniques that emphasize partnership rather than authority [31] could help establish more equitable relationships. Clinicians could benefit from annual continuing education courses that enhance communication skills with diverse patients. Regular self-assessment through instruments like the Implicit Association Test (IAT) can help clinicians identify and address biases that may influence their clinical decisions [50].\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B33-healthcare-13-01230\", \"B51-healthcare-13-01230\", \"B52-healthcare-13-01230\", \"B53-healthcare-13-01230\"], \"section\": \"4. Discussion\", \"text\": \"Medical education should integrate anti-racism training throughout curricula, rather than as isolated modules. This training should directly address the false beliefs about biological differences between races [33] and explain how historical misconceptions about race continue to influence modern practice and contribute to disparities in pain management and treatment recommendations. Medical education should incorporate the lived experiences of Black patients through case studies and patient narratives. For example, participants\\u2019 accounts of clinician microaggressions\\u2014brief verbal or non-verbal disparagements [51,52,53], including dismissiveness, biased assumptions, and inappropriate jokes\\u2014should be integrated into medical training. Exposing students to these experiences and their impact on patient trust and care continuity may enhance empathy and foster cultural humility.\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B54-healthcare-13-01230\", \"B55-healthcare-13-01230\"], \"section\": \"4. Discussion\", \"text\": \"Healthcare policy should mandate accountability measures to address racial disparities in care quality. State policymakers should require healthcare institutions to implement standardized bias and discrimination reporting systems with data submitted to a central repository. Such systems could be modeled after the Bias Reporting Tool (BRT) developed by UW Medicine in Seattle, Washington [54]. These systems should include clear evaluation metrics, including analysis of reported incidents and patient satisfaction surveys, to measure progress. Implementing this approach across states would enable the identification of systemic patterns requiring targeted intervention. Policymakers should also establish targeted funding streams and incentive programs to increase racial diversity among clinicians, which would expand patient access to race-concordant care. To address retention and prevent burnout of clinicians of color, policymakers should create financial incentives for healthcare institutions that implement peer support networks, provide dedicated mental health resources, ensure reasonable workload distributions, and create \\u201csafe space\\u201d groups where professionals of color can share experiences and strategies for navigating workplace challenges. These initiatives should also support the recruitment of Black healthcare professionals through structured mentorship opportunities and protected time for community engagement initiatives. This recommendation is supported by our finding that participants actively sought race-concordant care and is consistent with research demonstrating how racial concordance improves patient trust and adherence to treatment recommendations [55].\"}, {\"pmc\": \"PMC12154956\", \"pmid\": \"\", \"reference_ids\": [\"B56-healthcare-13-01230\"], \"section\": \"4. Discussion\", \"text\": \"Equipping Black men with effective self-advocacy strategies is essential for navigating potentially dismissive or biased healthcare encounters. Healthcare organizations should partner with trusted community centers and churches to develop and distribute culturally relevant self-advocacy resources to Black men and train health workers who can connect clinical care to their everyday experiences. Self-advocacy resources, such as question guides, patient rights information, and approaches for seeking second opinions, can empower Black men to secure thorough examinations, clear explanations, and appropriate care. Recent research underscores the value of these approaches, showing that patient self-advocacy can reduce the impact of physicians\\u2019 implicit biases [56], making these tools particularly valuable for Black men seeking equitable healthcare. Patient advocacy organizations should collaborate with healthcare institutions to establish patient advisory boards with significant representation from Black men. These boards could provide input on policies, procedures, and communication practices to ensure they address the concerns highlighted in our study.\"}]"

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