Many people of color in this country say they have to change the way they dress and mentally brace themselves for potential mistreatment when they visit the doctor. That's one of the sobering findings of a large new survey that probes the extent and implications of discrimination in American life, including health care.

The survey was conducted by the health research organization KFF. Researchers polled a nationally representative sample of nearly 6,300 adults.

The good news is that, among those that had sought health care in the past three years, people reported having positive and respectful interactions with their health care providers most of the time.

But the survey also uncovered troubling differences along racial and ethnic lines. Black, Hispanic, Asian and American Indian and Alaska native adults were much more likely than their white counterparts to report having negative interactions during health care visits.

"Things like a provider not listening to them, not answering a question or responding to a direct request, not prescribing pain medication that they thought they needed," says Samantha Artiga, director of racial equity and health policy at KFF.

For example, twice as many Black women who'd given birth in the last decade said they'd been refused pain medications they'd thought they'd needed, compared to white women. Numerous previous studies have found that Black patients are less likely to receive appropriate pain medication than white patients.

And overall, at least a quarter people of color said that doctors were less likely to involve them in decisions about their care. In some cases, Artiga says some survey respondents shared specific stories in which their concerns were initially dismissed, only later to be found to be a serious health condition.

Artiga says these types of experiences with unfair treatment may help explain why large shares of the respondents of color who took the survey said they took certain steps to prepare for health care visits at least some of the time.

"For example, feeling like they have to dress very carefully or take a lot of care with their appearance in order to be respected and listened to by their health care provider, or saying that they sometimes prepare for possible insults from health care providers during health care visits," Artiga says. Six-in-10 Black respondents said they are careful about how they present themselves and/or expect to be insulted in health care settings.

Another disturbing finding of the study is that Black adults with self-reported darker skin tones report more discrimination in everyday life. Sixty-two percent of Black adults who say their skin color is "very dark" or "dark" reported incidents of discrimination in the past year, compared to 42% Black adults who say their skin color is "very light" or "light."

People of color were much more likely to report having respectful, positive interactions when their health care providers shared their racial or ethnic background.

That's in line with a growing body of research that has found patients of color are more likely to be satisfied with health care interactions, and more likely to adhere to medical recommendations, when their doctors look like them. One recent nationwide study even found that Black patients lived longer if they resided in counties with more Black physicians.

However, data from the Association of American Medical Colleges show Black and Hispanic doctors remain vastly underrepresented relative to their share of the U.S. population.

"There's a real opportunity here in terms of increasing the diversity of the healthcare workforce to have positive impacts in people's interactions in the healthcare system," Artiga says.

The survey was conducted in the summer of 2023 and is the first in a series of studies KFF plans to do on the effects of racism and discrimination.