August 13, 2007

Medical doctors' unconscious racism affecting patient care

Does lurking racism affect the workings of our major institutions - government, the judiciary, medicine, and education? And how, if it is underground, can we even answer this question with anything more than speculation and opinion?

Where there's a will, there’s a way.

Psychological scientists have developed a tool called the Implicit Association Test that scientifically measures unconscious racism. That is, it can tell whether you have racial biases that you are not aware of. The test is being used to empirically assess for the presence of individual-level racism in societal institutions.

In the field of medicine, for example, we know that African Americans have higher infant mortality rates and death rates from cervical cancer, heart disease, and stroke than white patients. But are these differences due to outright racism on the part of doctors, or to other factors such as socioeconomic status or lack of health insurance?

While such macro-level factors are undoubtedly significant, a group of Harvard University psychology researchers have used the Implicit Association Test to prove that unconscious racial bias affects how doctors treat heart attack victims.

The study, reported in the current (September) issue of the Journal of General Internal Medicine, involved giving a hypothetical vignette to doctors about a patient suspected of having had a heart attack. In some cases, the patient was described a white; in others, he was described as black. In all other ways, the patient was the same. Doctors who scored high in unconscious racism on the Implicit Association Test tended to withhold aggressive treatment from the black patients.

The current issue of the journal also reports on another study – this one involving real patients - suggesting that similar racial factors play into doctors' decisions about whether to refer women for osteoporosis screening after a hip fracture.

These and other, recent studies suggest that the empirical study of individual-level racism is hitting its stride. Indeed, I posted recently about similar studies of automatic racial processes in the forensic realm, and how subtle racial bias on the part of police, probation officers, and others affects rates of arrest, prosecution, and incarceration.

Since unconscious bias is by definition outside of conscious awareness, and since racism is not as popular as it used to be, no one wants to admit to harboring it. Thus, it is difficult to confront without the empirical evidence of its existence.

Unfortunately, such study has barely touched the mental health field. Although we know that psychiatric diagnosis and treatment vary tremendously by race, for everything from schizophrenia to childhood Attention Deficit/Hyperactivity Disorder, the empirical study remains to be done on why this is so. Until we can identify the precise mechanisms, disparities will remain, affecting the quality of care and in some cases life or death itself.

You can take the Implicit Association Test online.

Reference: Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, Iezzoni LI, & Banaji MR. (2007). Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients. Journal of General Internal Medicine, 22, 1231-1238.

Photo credit: Vanity Press (Creative Commons license)