How to beat racial bias in health care

The problem is often unconscious, experts say

Research suggests there are clear racial biases in health care, but new training programs are showing promise in helping providers change their behavior, April Dembosky reports for KQED.

Racial disparities in treatment and outcomes are well-documented. For instance, a study in the American Journal of Public Health found black patients are often prescribed less pain medication than white patients when presenting with the same symptoms. And other studies have found black patients with chest pain are referred to advanced cardiac care at lower rates.

The cause, experts say, is often unconscious racial bias that is hard to identify and change.

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According to Howard Ross, a management consultant who has worked with medical schools on cultural competency training, the first step to reducing bias is to recognize that bias in unavoidable. "We can no more stop having bias than we can stop breathing," he explains.

And bias is even more difficult to combat in the fast-paced, high-stress world of health care. "If you're doing triage in the emergency room, for example, you don't have time to sit back and contemplate, 'Why am I thinking about this?' You have to instantaneously react," Ross observes.

Tackling the issue

University of California, San Francisco (UCSF) School of Medicine is one of several medical schools that has added anti-bias training to its curriculum.

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The training program begins with UCSF students taking a computer program that measures their unconscious racial biases. At a recent class, instructor Rene Salazar asked students to share the results of their test—and when no one did, Salazar admitted that when he first took the test, he discovered he had an unconscious racial bias against African Americans. Salazar is not alone; studies show 75% of people show a similar bias.

"Like it or not, all of us hold unconscious beliefs about various social and identity groups," Salazar told the class. "You're going to see this in every hospital. It's going to be an issue."

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Salazar advised the class on how to be mindful of their existing biases. "A trick that I use is that I pause before I walk in, take 10 seconds even, 15 seconds, just to try to clear your mind and go in with that clean slate," he said.

There have been few formal studies on this approach to anti-bias training, but Dembosky writes anecdotal reports are positive. And research on traditional diversity training programs suggests that—at a minimum—new approaches are needed.

A 2007 study in Harvard Business Review of 800 companies diversity training programs found most did nothing to reduce prejudice—and in some cases actually reinforced biases. "What happens is, ultimately, we feel bad about ourselves, or bad about the person that made us feel that way," Ross says of most diversity programs.

He wants to change that. "It's important to pause for a second and normalize this. And be OK with this," he says (Dembosky, KQED/Kaiser Health News, 8/20).


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