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.

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 a hypothetical vignette given to doctors regarding 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. Doctors who scored high in unconscious racism on the Implicit Association Test tended to withhold aggressive treatment from the black patients.

The same issue of the journal 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, it will be difficult to confront and eradicate 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, more empirical study remains to be done on why this is so. Until then, disparities are likely to remain.

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