Yelp reviews of health providers could be a key to identifying patterns of discrimination in healthcare settings, according to a new JAMA investigation. 

Complaints about an individual actor were the most common, followed by reports of institutional racism. Researchers also found that about half of the complaints involved clinical spaces. 

"This exploratory qualitative content analysis of consumer reviews highlights the pervasive nature of discrimination in medicine through its 1) presence in clinical and nonclinical spaces, 2) display by individual and institutional actors, and 3) multidirectional flow between healthcare consumers and practitioners," researchers wrote. 

TOP-LINE DATA 

Researchers zeroed in on 182 reviews that signaled discrimination. Of those reviews, 39% cited an individual player demonstrating acts of discrimination. These players included both clinical staff, such as doctors and nurses, and nonclinical staff, including volunteers and security officers. 

The study found that 29.1% of the reviews were categorized as examples of institutional racism. Researchers also examined the location of reported discrimination and found that 48.9% of incidents happened in a clinical setting. Another 13.7% of incidents took place in nonclinical space, and 36.6% of cases were "consumer-directed at the healthcare workforce."

Researchers also identified six themes throughout the reviews: "acts of commission, omission, unprofessionalism, disrespect, stereotyping and dehumanizing."

HOW IT WAS DONE 

Researchers pulled Yelp reviews from 100 randomly selected acute hospitals in the U.S. They then used a word-filtering system to pinpoint reviews related to discrimination. 

Study authors developed a codebook to help categorize and review the discrimination reported. 

THE BACKGROUND 

The healthcare industry has a history of discrimination. However, recently there has been an uptick in research on the issue. 

"Health inequities exist across disciplines and patient characteristics," study authors wrote.  "Although outdated models focused on biological drivers of inequities, newer studies have shifted attention toward structural and interpersonal discrimination’s primary role in driving inequities.

"Many studies have demonstrated how discrimination propagates worse health outcomes for minority populations across race, sex, gender, sexual orientation, age and disability. Consequently, there are increasing efforts in identifying and reducing experiences of discrimination within healthcare."

A 2020 JAMA study found that 17.3% of Black and Hispanic survey takers reported discrimination based on race or ethnicity. Respondents reported education or income level, weight and age as other factors that led to discrimination.