Understanding the Patient Experience and Bias in Healthcare Question Title * 1. What is your age range? (Required.) 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 2. What gender do you identify as? (Required.) Male Female Transgender Non-binary Question Title * 3. What is your ethnicity? (Required.) White or Caucasian Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Another race Question Title * 4. Have you ever felt you were treated differently by a medical professional because of one or more of these factors? (Required.) Race Ethnicity Being Female Identifying as LGBTQIA Body Size Age Other (please specify) Question Title * 5. Have you ever felt you were not listened to by a current or past medical professional? (Required.) Yes No Question Title * 6. Have you ever changed doctors because you did not like the way a medical professional treated you? (Required.) Yes No Question Title * 7. If you had a choice of equally competent doctors, which factor would be more important in selecting your physician? (Required.) Same gender as me Same race/ethnicity as me Question Title * 8. What would your primary reason be for your choice in question 7? (Required.) I believe they would understand me better. I believe they would listen better. I would be more comfortable with them. I want to support people like me. Other (please specify) Question Title * 9. Who do you feel is most likely to practice empathy when you are undergoing medical treatment? (Required.) Physician Physician Assistant Nurse Practitioner Nurse Other (please specify) Question Title * 10. What percentage of the time do you feel your current doctor listens to you? (Required.) 0 100 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 11. Please explain why feel your doctor does not listen to you. Question Title * 12. What percentage of the time do you follow your doctor's treatment instructions? (Required.) 0 100 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 13. Please explain why you do not follow your doctor's treatment instructions. Question Title * 14. What percentage of the time do you feel vulnerable when you are at a medical appointment/procedure? (Required.) 0 100 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 15. Please explain what makes you feel vulnerable during a medical appointment/procedure. Question Title * 16. How would you rate the following factors in your selection of a medical professional? Not important Somewhat important Important Very important Their reputation/knowledge Their reputation/knowledge Not important Their reputation/knowledge Somewhat important Their reputation/knowledge Important Their reputation/knowledge Very important Recommendation from family/friend Recommendation from family/friend Not important Recommendation from family/friend Somewhat important Recommendation from family/friend Important Recommendation from family/friend Very important How they listen to me during appointments How they listen to me during appointments Not important How they listen to me during appointments Somewhat important How they listen to me during appointments Important How they listen to me during appointments Very important How friendly they are How friendly they are Not important How friendly they are Somewhat important How friendly they are Important How friendly they are Very important How they explain things to me How they explain things to me Not important How they explain things to me Somewhat important How they explain things to me Important How they explain things to me Very important Other (please specify) Question Title * 17. Which of the following best describes your current relationship status? (Required.) Married Widowed Divorced Separated In a domestic partnership or civil union Single, but cohabiting with a significant other Single, never married Prefer not to answer Question Title * 18. What is the highest level of education you have completed? (Required.) Graduated from high school 2 years of college Graduated from college Completed graduate school Question Title * 19. What is your total household income? (Required.) Less than $20,000 $20,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 $75,000 to $99,999 $100,000 to $149,999 $150,000 or More Question Title * 20. Would you share a story about when you felt dismissed by a medical professional? Please do not include personal information or names. Done