Racial Bias Puts Patients at Risk
by Brookshield Laurent, D.O.
Do blacks have less sensitive nerve endings than whites?
It’s an outrageously racist question. Yet in a recent survey, 14 percent of white second-year medical students answered yes. In that same survey, about 40 percent of white first- and second-year medical students expressed the belief that black patients have thicker skin than their white counterparts.
These findings point to an awful reality: Racial biases and misconceptions remain rampant in our health care system — and medical schools aren’t doing enough to address the issue. The prejudice in our health care system is hazardous. Addressing this hazard needs to start with medical educators.
Implicit bias — the unconscious negative evaluation of a particular group — can affect medical judgment. Consider a 2008 Journal of the American Medical Association study, which found that black and Latino patients admitted to an emergency room with bone fractures or kidney stones are less likely to receive the recommended levels of painkillers relative to the average white patient.
Research from Harvard Medical School professor Joseph Betancourt shows that blacks are less likely than whites to receive kidney transplants. And compared to the general male population, African American men with prostate cancer are less likely to receive chemotherapy and radiation.
America’s health care system provides a far different standard of care to minority patients, oftentimes for no discernible reason other than skin color. This form of prejudice isn’t just unfair; it’s potentially life-threatening.
Since many of these attitudes are established long before physicians begin their careers, medical schools have a significant role to play in addressing the problem. The first step is to help students recognize their biases early.
Several medical schools are already making progress.
First-year medical students at University of California, San Francisco, for instance, participate in a workshop that begins with an implicit bias test to gauge attitudes about various identity groups.
Students at my own institution, New York Institute of Technology College of Osteopathic Medicine, engage in a variety of simulated interactions with patients of different races, socio-economic backgrounds, and sexual orientations. Based on these scenarios, students investigate how their unconscious biases affect their behavior.
Simulations and classwork can only do so much to change attitudes, of course. Medical schools need to provide students with frequent opportunities to engage with patients of different backgrounds.
NYIT’s medical students, for instance, participate in a free, monthly clinic in Central Islip, a low-income town on Long Island with a large minority population.
Medical educators must also eliminate teaching materials that reinforce implicit biases. Such materials are remarkably common. In fact, a report published earlier this year in Academic Medicine found that, in many medical school lectures, race is routinely discussed as a straightforward medical risk factor for certain conditions, not as a complex social concept.
Such a biological view of race not only bolsters destructive prejudices; it obscures the many ways in which social forces and biases can dramatically affect the health of minority patients.
What’s most important is that medical schools aggressively pursue new strategies for combating implicit bias, and share their lessons with the larger healthcare community. Without a substantial effort to produce culturally competent, impartial medical practitioners, the lives of minority Americans will remain at risk.
Brookshield Laurent, D.O., is vice chair of the Department of Clinical Specialties at New York Institute of Technology College of Osteopathic Medicine.