October 29, 2008

Study Finds Physicians Have Subconscious Bias For Whites

Researchers at the University of Washington in Seattle said Tuesday that doctors might subconsciously favor whites over blacks.

The findings reinforce previous research that showed U.S. blacks receive inferior care for cancer and other conditions compared with whites. For example, studies have shown U.S. blacks are more likely than whites to die from strokes, diabetes, cancer and heart attacks.  Other studies have shown this disparity persists even when factors such as education level, incomes and insurance coverage are equal.

"This supports speculation that subtle race bias may affect health care, but does not imply that it will," Janice Sabin of the University of Washington in Seattle told Reuters, adding that it is still too early to know if the findings directly link to inferior care for blacks.

However, "we have to remember people are not racist if they hold an implicit bias," Sabin said in a statement.

The research used data from a study of more than 400,000 people, including 2,535 who said they were doctors, who completed an online survey between 2004 and 2006 about their racial attitudes. 

The test looked for subconscious signs of bias rather than overt racism. For instance, participants were asked to rapidly rate photos of blacks and whites as either positive or negative.

"We don't call what these tests show prejudice. We talk about it as hidden bias or unconscious bias, something that most people are unaware they even possess," Anthony Greenwald of the University of Washington, who created the test, told Reuters.

Of the entire sample, 86 percent said they lived in the United States and 69 percent said they were white.  Of those saying they were physicians, 76 percent reported living in the United States and 66 percent identified themselves as white.

The results found that doctors of all races and ethnic groups showed an implicit preference for whites versus blacks, except for black doctors who showed no preference for either group.

"The implicit bias effect among all the test-takers is very strong," said Sabin.

"People who report they have a medical education are not different from other people, and this kind of unconscious bias is a common phenomenon."

The study demonstrates that diversity training should be included in U.S. medical education, said Sabin, who presented the findings at the American Public Health Association's annual meeting in San Diego.

Meanwhile, a separate University of Washington study found racial and ethnic disparities in patient health-care experiences at more than 1,500 physician practices, with minority patients reporting worse experiences than white patients.

The findings suggest that Hispanic, Native American, and black patients are often visiting less patient-centered physician practices.

"Our findings suggest that there are statistically significant ethnic disparities in physician-patient communication, access to care, and care coordination, even among comparably insured patients in a variety of health-care markets," said Dr. Hector Rodriguez, the study's lead author and assistant professor of health services at the UW School of Public Health and Community Medicine, in a press release.

The study is the first to examine the contribution of individual physician practices to racial and ethnic disparities in patients' healthcare experiences. The results show that Hispanic, black, and Native American patients were concentrated in lower-performing primary care practices, while Asian and Pacific Islander patients reported worse experiences in the same practices as whites.

Rodriguez said the fact that Asian and Pacific Islander patients experience disparities in care within the same practices as whites suggests these patients either experience discrimination or tend to report lower quality experiences due to cultural norms.

The study surveyed 49,000 patients in 27 medical groups in California, and was   part of the Integrated Healthcare Association's public-reporting initiative.

Rodriguez said that ethnic disparities in patient experiences might be best addressed by targeting quality improvement efforts in low-performing practices with high concentrations of minority patients.  However, primary care practices that serve high concentrations of Latinos and other minority groups are often located in areas with severe physician shortages and many uninsured patients. As a result, improvement efforts should take these factors into consideration.

The study appears in the October issue of the Journal of General Internal Medicine.


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