'Maybe you should have a bowl of ice cream': Inequities in patient-clinician interactions among individuals with chronic low back pain.

Prior literature has shown inequities in patient-clinician interactions experienced by individuals with chronic low back pain (CLBP) with underlying pain-related stigmatization and invalidation. Yet, there is a notable gap in understanding how these inequities intersect with multiple systems of oppression, including racism and sexism. This qualitative study examined intersectional perspectives and experiences of patient-clinician interactions among individuals with CLBP. Semi-structured interviews were conducted after the participants engaged in simulated enhanced or limited patient-clinician interactions as part of an experimental study. Participants were asked to compare the simulated patient-clinician interaction to their real-life patient-clinician interactions for their CLBP. The study included 50 participants with CLBP for at least three months and half the days in the past six months. Participants were Black and multi-racial women (n=14), Black and multi-racial men (n=12), non-Hispanic White women (n=12), and non-Hispanic White men (n=12). A basic qualitative approach with principles from constructivist grounded theory and intercategorical intersectional research were used to propose three core categories when describing inequities in patient-clinician interactions: higher-level systems (subcategories: institutional, community, macro-level), the patient-clinician interaction (subcategories: being taken seriously, person-centered care), and effects of the patient-clinician interaction (subcategories: indirect, direct effects). Inequities were identified across all categories, disproportionately affecting Black and multi-racial women. Black and multi-racial women also distinctly shared a wider range of both positive and negative patient-clinician interactions and effects from these interactions, and potential pathways to more equitable care. These findings highlight the need for multi-level interventions to promote more equitable care for individuals with CLBP. PERSPECTIVE: This qualitative study examined intersectional perspectives and experiences of patient-clinician interactions among individuals with CLBP. Multiple intersecting systems shaped inequities in patient-clinician interactions. Black and multi-racial women shared the broadest range of patient-clinician interactions, distinctly discussed intersecting systems of oppression, and highlighted pathways to more equitable care.