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Too Stubborn to Care for: The Impacts of Discrimination on Patient Noncompliance

Posted by on Wednesday, March 20, 2024 in Articles, Volume 77, Volume 77, Number 2.

Alice Abrokwa | 77 Vand. L. Rev. 461

The role of implicit racial biases in police interactions with people of color has garnered increased public attention and scholarly examination over time, but implicit racial bias in the healthcare context can be as deadly, particularly when it intersects with ableism and sexism. Researchers have found that medical providers are more likely to consider Black patients “noncompliant,” meaning the patient has not adhered to recommended treatment, even without evidence Black patients are less compliant than other patients. Being labeled noncompliant can have grave health consequences; providers are less likely to treat pain aggressively when they consider a patient noncompliant and, subject to certain legal and professional constraints, can deny care altogether.

Existing legal scholarship has identified thoughtful proposals to limit providers’ ability to reject noncompliant patients; this Article expands upon that work by focusing attention on why Black patients are perceived as less compliant in the first place. This Article further examines the ways in which, among other barriers to compliance, systemic forms of discrimination can lead some patients to actually become noncompliant. To address the impacts of discrimination on patient noncompliance, the Article first builds from a concept in disability civil rights law concerning reasonable modifications. The Article calls for providers and the healthcare system to shift from expecting absolute compliance to providing both individualized modifications and those modifications that have collective benefit. The Article further calls upon providers to redesign their approach to patient care in ways that mitigate provider biases and structurally make it easier for patients to follow a treatment plan they agree with. In legal matters in which a patient’s reported noncompliance is relevant, the Article calls for legal decisionmakers and policymakers to account for how stereotyping and systemic discrimination can affect both providers’ perceptions of and patients’ actual reasons for noncompliance.

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Alice Abrokwa