health bias

Numerous studies have found that African Americans get inferior care for cancer, diabetes and a variety of other conditions compared to Whites, but for years, experts concerned about the disparities struggled to understand why. Over the past decade, a series of studies have shown racial bias definitely plays a part in how doctors treat Black patients.

Doctors, like others, are racially biased

Most of the studies use the Race Attitude Implicit Association Test to capture subconscious – or implicit – bias by asking people to associate “good” or “bad” words quickly with photographs of Black and White faces. Good words include joy, love, peace and laughter. Bad words include agony, horrible, evil and nasty.

In study after study, researcher found the majority of doctors showed an implicit preference for White Americans compared to Black Americans. However in study after study, Black doctors were the exception, because they, on average, did not favor either group.

Although bias is common in the general population, people are not considered “racist” if they “hold an implicit bias.”

“The implicit bias effect among all the test-takers is very strong,” said Janice Sabin, who was part of a 2009 research team on racial bias in doctors. ”People who report they have a medical education are not different from other people, and this kind of unconscious bias is a common phenomenon. The key is developing a system where quality health care is provided despite such attitudes.”

Impact of Bias

A 2012 study looked into how this racial bias impacted patient care and found that primary care physicians who hold unconscious racial biases tend to dominate conversations with African-American patients during routine visits, paying less attention to patient’s social and emotional needs and making these patients feel less involved in decision making related to their health.

Specifically, this John Hopkins based study found racial bias showed up as longer visits (by about 20%) characterized by slower speech speed by physicians when interacting with African-American patients. The researchers suggest that although longer visits with slower-paced dialogue might be seen as positive, the African-American patients responded to these visits negatively, reporting lower levels of trust and confidence in the physician and lower perceptions of being involved in treatment decisions.

The researchers suggest that patients may interpret this pattern of communication as conveying an authoritarian and critical tone that creates an overall negative impression – regardless of longer visit duration.

In a 2017 study, published in the April 2, 2018 journal of Social Science and Medicine, a team found American clinicians rated White patients as significantly more likely to improve and more likely to adhere to recommended treatments than Black patients, and to be more personally responsible for their health than Black patients. 

The results are in a way, a self-fulfilling prophecy.

“If patients have good patient-centered interactions with their doctors, we know they’re more likely to follow through with care, make follow-up appointments and better control diseases,” said Lisa a Cooper, M.D., M.P.H, who was part of the John Hopkins study.

“We need to continue to examine if medical providers have preferences for some groups over others, either implicit or explicit, and how that affects treatment, expectation for patients success, and interactions with patients,” said “Sylvia Perry, PhD, a co-author of the 2017 study.

Public perception is that medicine is based only on science, which is removed from bias and racism, said Natalia Neha Khosla, also a co-author of the 2017 study.

“This work and scores of studies before show that’s not the case,” she said. “Science and medicine are not invulnerable to the effects of racism, because we are humans and are shaped by our environments.”

Addressing the Issue

While some White Americans like to pat themselves on the back for being racially color-blind, a 2015 study published in the Journal of Experimental Social Psychology found that White Americans aware of their biases are better equipped to address contemporary racial challenges, where prejudice is often expressed in subtle, unintentional and unconscious ways.

“The first step towards reducing these subtle biases and correcting behavior that is sometimes unintentionally hurtful, our research shows, is personal awareness, internalizing the fact that you may have subtle biases, said Sylvia Perry, the lead author of this study.

The study, of 902 white Americans, employed a variety of established psychological tests to assess racial attitudes and a new assessment that gauged subjects’ “bias awareness,” a trait never before defined and researched. The bias awareness test asked subjects to score a series of statements such as, “When talking to Black people, I sometimes worry that I am unintentionally acting in a prejudiced way” designed to uncover awareness of subtle bias.

Those who scored high in bias awareness were more able to internalize negative feedback about their racial attitudes, telling researchers they felt badly when given false feedback that they had a strong preference for whites over Blacks, and to take positive corrective steps, volunteering in greater numbers for a diversity initiative the researchers invented, than those with low bias awareness, who reacted defensively to negative feedback and were unwilling to change their behavior.

Both results occurred regardless of how subjects scored on other tests they were given that measured their level of prejudice or their motivation to be non-prejudiced. The key factor in developing what the study calls “concerned awareness” of racial bias is acceptance, Perry said. “If you accept these things in yourself, you’re on the road to making things better.”

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