Doctors' racial biases may harm black patients, study suggests

More research is needed to see how bias impacts real-world patient care

Many white medical students and residents have false medical beliefs about black patients that may lead to systematic undertreatment of pain, a new study finds.

At 70 schools, medical students stage 'white coat die-in'

Past research has shown large racial disparities in pain treatment. For instance, a 2000 study from Emory University found that 50 percent of black patients with bone fractures received painkillers, compared with 74 percent of white patients.

A new study from the University of Virginia published in Proceedings of the National Academy of Sciences suggests misinformation and bias among doctors may help explain the disparities. For the study, researchers asked 222 white medical students and residents to classify 15 statements about physiological differences between races as either:

  • Definitely, probably, or possibly true; or
  • Definitely, probably, or possibly untrue.

Four of the statements were true, such as that black patients are at higher risk of developing cardiovascular disease. The other 11 statements, such as "blacks' skin is thicker than whites," were false.

Overall, about 50 percent of medical students and residents thought at least one of the false statements was definitely, probably, or possibly true. For instance:

  • 40 percent of first- and second-year medical students and 25 percent of residents said blacks have thicker skin;
  • 14 percent of second-year medical students said blacks have less sensitive nerve endings than whites; and
  • 12 percent of third-year medical students said blacks age more slowly than whites.

The researchers also asked students and residents to complete two patient case studies—one with a black patient and one with a white patient—in which they evaluated patients' pain and came up a with a treatment plan. Each case study was also evaluated by a team of experienced doctors who did not know the race of the patients.

Overall, white medical students and residents rated the pain of black patients as less severe, and they were less likely to prescribe painkillers. And "[study participants] who endorsed … false beliefs showed more bias and were less accurate in their treatment recommendations," notes Kelly Hoffman, a University of Virginia doctoral candidate in psychology who led the study.

How to beat racial bias in health care

"Racial bias in pain perception has pernicious consequences for accuracy in treatment recommendations for black patients and not for white patients," the researchers wrote.

Understanding treatment disparities

But Hoffman also notes that, according to a separate questionnaire administered as part of the study, the medical students and residents were less biased than the general white population. "It's not the case that these particular medical students and residents are just more racially biased," she explains. "It's just these are very common beliefs that are very pervasive across our society."

She also says that more research is needed to determine if practicing physicians hold these beliefs and if they affect treatment in the real word (Somashekhar, "To Your Health," Washington Post, 4/4; Healy, "Science Now," Los Angeles Times, 3/4; Cornish, "All Things Considered," NPR, 3/5).

Guarding against racial bias: Are you leading an evidence-based organization?

Despite the shift toward broad acceptance of evidence-based practice (EBP) among medical staff, over half of physicians report not actually using guidelines day-to-day when they are available. As a result, organizations continue to see tremendous variation in clinical practice—as well as in costs and outcomes.

Our infographic outlines four principles you can use to support EBP at your organization, along with action steps to implement each one and pitfalls to avoid along the way.

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