How you speak may affect your access to healthcare
A person’s voice can determine their access to mental and physical healthcare. How can we ensure equitable treatment for everyone, regardless of how they sound?
Think back to the last time you scheduled a doctor’s appointment. Was it an easy process, or did you stumble on some puzzling roadblocks?
We all have minds and bodies that benefit from periodic check-ups, yet gaining access to mental and physical care can often be elusive.
Some of the obstacles we encounter are within our control: maybe we have fears about seeking professional help because we think it means something is wrong with us.
At other times, things beyond our control get in the way. Our insurance, for instance, may limit our choice of the resources we have access to.
These hurdles may come as no surprise – many of us have personally experienced them. But here’s something you probably have never considered to be a roadblock to accessing care: how you speak and sound, and even your name.
A 2016 study by Heather Kugelmass (“Sorry, I’m Not Accepting New Patients”) examined how the way a person speaks and sounds – their language patterns and accent – determined their access to mental healthcare.
Kugelmass hired actors to call therapists across New York City and leave voicemails requesting an appointment. The content of these voicemails was identical: each person called with the same symptoms, the same insurance coverage, and the same request for an appointment at the same timeslots. But while the content of the messages remained the same, the word choice, grammar, and accent the actors used varied. Kugelmass made each speaker sound like a middle-class or working-class caller, and also made them give a name with their message that signaled that the caller was likely to be Black or White.
Over 300 psychotherapists each received two voice messages: either from (implied) Black and White middle-class callers or from (implied) Black and White working-class callers.
Most of us would imagine that as long as a therapist has an available slot for a new patient, it would hardly matter what group the patient belonged to. But that’s not what the data revealed.
When all else was equal, the little bits of information that signaled social status and race influenced who cleared the first hurdle of simply landing an appointment. Kugelmass found that the middle-class voice was offered appointments at a rate almost 3x higher than the working-class voice. And within those middle-class voices, those with White-sounding names (“William Anderson”) were more likely to get appointments than callers with Black-sounding names (“Jamal Carter”).
The information about class and race that voices carry doesn’t just impact access to psychotherapy. In one study of 804 primary care offices, voicemails left by prospective patients with Black-sounding names were 44% more likely to be asked about their insurance status before receiving an appointment than patients with White-sounding names.
Making healthcare more equitable
Regardless of which side of the phone you’re on, we can agree that this doesn’t represent an equitable healthcare system; therapists themselves would acknowledge that they shouldn’t accept this kind of bias in their own behavior.
So: if you’re a healthcare provider, or you simply wish to improve your decision-making, what can you do?
- Recognize that very little information can evoke bias in us. You don’t need to see a person to be biased: their voice is enough. Just a few words or a name is sufficient to shape your behavior towards them … without your knowing it.
- Work to remove the subtle cues that can influence your decisions. Find ways to remove voice from your decision-making entirely. Consider ditching the voicemail and instead set up an online appointment system that only asks about the things you really care about: is the patient in your network? Do your schedules align? Are their concerns within your realm of expertise?
- Be proactive in your recruiting. Of course, we can’t eliminate all the ways data about people reaches our minds, so bias will still undoubtedly creep in. We’re only human, after all! One way to compensate for this bias is to actively seek out populations that are the most vulnerable or underserved (by you!) when adding to your patient pool or attaining clients. This may require being a little imaginative about where you should advertise, who you ask for referrals, and so on.
- Collect data to hold yourself accountable. One of the easiest ways to check your bias is to simply collect data about your clients. Are you and your organization serving equal numbers of men and women, middle-class and working-class people, Black and White people? Having this evidence will let you know if you are truly providing equitable care.
There are many small and consistent steps we can take towards ensuring equal and equitable treatment, both in and outside of healthcare. Doing so helps us be the professionals we wish to be and do the good and fair work we ourselves want to do.
Voice patterns can impact access to critical services like healthcare.
To outsmart voice bias and make your decisions more objective, find ways to remove voice from the equation entirely. For instance, try using an online form to collect information instead of a phone call.
Keep yourself accountable by collecting data. Are you unintentionally serving some clients better than others? Are certain groups not even attempting to get your services?
Kugelmass, H. (2016). “Sorry, I’m not accepting new patients”: An audit study of access to mental health care. Journal of Health and Social Behavior, 57(2), 168-183.
Wisnieski, J. M., & Walker, B. (2020). Association of simulated patient race/ethnicity with scheduling of primary care appointments. JAMA Network, 3(1), e1920010-e1920010.
Published August 30, 2021
This article was written by Olivia Kang, Patricia Liu, Caitlyn Finton, Alex Sanchez, and Mahzarin Banaji.
Artwork by Olivia Kang and Patricia Liu.
Support for Outsmarting Implicit Bias comes from Harvard University, PwC, P&G, and Johnson & Johnson.