The Eugenics movement. Segregated Hospitals. The Tuskegee Syphilis Study. These are some of the most obvious ways racism and medicine intersected in the 20th century. But even in the contemporary United States, racial bias continues to factor into the health care people of color receive. While racial minorities are no longer unknowingly used as guinea pigs for medical research or denied entry into hospitals because of their skin color, studies have found that they don’t receive the same standard of care as their white counterparts. Lack of diversity training in health care and poor cross-cultural communication between doctors and patients are some of the reasons why medical racism persists.
Unconscious Racial Biases
A major reason racism continues to affect healthcare is because many physicians remain unaware of their unconscious racial biases, according to a study published in the American Journal of Public Health in March 2012. The study found that a staggering two-thirds of doctors exhibited racial bias towards patients. The researchers determined this by asking doctors to complete the Implicit Association Test, a computerized assessment that calculates how fast test subjects associate people from different races with positive or negative terms. Those who link people of a certain race with positive terms more quickly are said to favor that race. The doctors who participated in the study were also asked to associate racial groups with terms that signal medical compliance. Researchers found that the doctors exhibited a moderate anti-black bias and thought of their white patients as more likely to be “compliant.” Forty-eight percent of the health professionals were white, 22 percent were black and 30 percent were Asian. The non-black health care professionals exhibited more pro-white bias, while black health care professionals did not exhibit bias in favor or against any group.
The outcome of the study was especially surprising given that the doctors who participated served in inner city Baltimore and were interested in serving underprivileged communities, according to lead author, Dr. Lisa Cooper of the John Hopkins University School of Medicine. Beforehand, the physicians never guessed that they preferred white patients to black ones. “It’s hard to change subconscious attitudes, but we can change how we behave once we are made aware of them,” Cooper says. “Researchers, educators and health professionals need to work together on ways to reduce the negative influences of these attitudes on behaviors in health care.”
Racial biases in health care also influence the way doctors communicate with their patients of color. Cooper says that doctors with racial biases tend to lecture black patients, speak more slowly to them and make their office visits longer. Doctors who behaved in such ways typically made patients feel less informed about their health care. Researchers determined this because the study also included an analysis of recordings of visits between 40 health care professionals and 269 patients from January 2002 to August 2006. Patients filled out a survey about their medical visits after meeting with doctors. Poor communication between doctors and patients can result in patients canceling follow up visits because they feel less trust in their physicians. Doctors who dominate conversations with patients also run the risk of making patients feel as if they don’t care about their emotional and mental needs.
Fewer Treatment Options
Bias in medicine may also lead physicians to inadequately manage the pain of minority patients. A number of studies have shown that doctors are reluctant to give black patients strong doses of pain medication. A University of Washington study released in 2012 found that pediatricians who exhibited a pro-white bias were more inclined to give black patients who’d undergone surgical procedures ibuprofen instead of the more potent drug oxycodone. Additional studies found that physicians were less likely to monitor the pain of black children with sickle cell anemia or to give black men visiting emergency rooms with chest pain complaints diagnostic tests such as cardiac monitoring and chest X-rays. A 2010 University of Michigan Health study even found that black patients referred to pain clinics received roughly half the amount of drugs that white patients received. Collectively, these studies indicate that racial bias in medicine continues to affect the quality of care minority patients obtain.
Lack of Diversity Training
Medical racism won’t disappear unless doctors receive the training necessary to treat a wide range of patients. In his book, Black & Blue: The Origins and Consequences of Medical Racism, Dr. John M. Hoberman, chair of Germanic studies at the University of Texas at Austin, says that racial bias persists in medicine because medical schools don’t teach students about the history of medical racism or give them appropriate diversity training. Hoberman told the Murietta Daily Journal that medical schools must develop race relations programs if medical racism is to cease. Such training is vital because doctors, as studies reveal, aren’t immune to racism. But it’s unlikely that physicians will confront their biases if medical schools and institutions don’t require them to do so.