Does a patient’s race influence physician’s decisions?
Are white physicians racist? The vast majority of them are not. Do white physicians hold unconscious biases against African Americans and Latinos? The overwhelming majority of them do. When less than 6% of physicians are African American or Latino, this fact has a big impact. Unconscious racial stereotyping and bias contributes to the health inequities suffered by African-American and Latino populations. A recent CNN story brought this issue into the public light again.
Physicians racial biases affect their clinical decision-making. In a landmark study by Schulman et al, African-American patients were less likely than whites to receive life-saving therapy for a heart attack — although everything about the patients’ presentation was the same except for the color of their skin. Schulman argued that racial bias against African Americans must be the reason for the disparity in the proposed therapy. Schulman’s finding has been replicated numerous times in the last 10 years. Each time, the researchers find that presumed racial bias affects the physicians’ clinic decisions, resulting in poorer quality care for African Americans. Each time, however, the researchers make no objective measurement of the racial bias.
In 2007, this changed. A study conducted by Green et al replicated the Schulman findings, showing that a group of emergency medicine and internal medicine physicians were more likely to recommend life-saving medical therapy for heart attack patients if they were white. However, Green et al used a psychometric instrument called the implicit association test (IAT) to measure unconscious racial bias in their study subjects. They objectively demonstrated that racial bias was associated with the preferential treatment of the white patients.
The Web-based IAT is a well validated tool that has been used in more than 400 studies and in more than 10 million subjects. Go to the Project Implicit website and check it out yourself.
Brian Nosek, PhD, an Associate Professor in the Department of Psychology at the University of Virginia and the Director of Project Implicit, and colleagues have a paper in the upcoming August 2009 issue of the Journal of Health Care for the Poor and Underserved that evaluates the unconscious racial biases of physicians.
When I asked Dr. Nosek about physicians’ racial biases, he noted that “Implicit biases are pervasive and have been linked to important behaviors, including treatment decisions by health care providers.” In discussing his recent study in the Journal of Health Care for the Poor and Underserved, Nosek said “we found that – in terms of implicit racial biases – medical doctors are much like the rest of us. We measured more than 2,500 MDs and their implicit preference for White people over Black people was similar in magnitude to JDs, PhDs, and people without advanced degrees.”