During the course of a person’s healthcare experience, treatment can serve as a beacon of optimism, providing reassurance that their condition will improve. When seeking assistance from medical practitioners, we anticipate receiving a diagnosis based on their substantial training. Nevertheless, individuals from communities of color may not always encounter this scenario. They are confronted with the prospect that the treatment they receive could be partial and devoid of alternative options. Rather than solely relying on scientific knowledge, healthcare professionals may sometimes permit implicit bias to infiltrate their thinking, influencing the course of treatment they prescribe. By exploring the experiences of individuals of color in North Carolina and analyzing research carried out on healthcare providers, we will examine how bias impacts the treatment received by patients.
Stereotyping of Black Community’s Illnesses
The black community often experiences being labeled as “predestined” or accountable for their illnesses, with healthcare providers stereotyping and attributing their illness to genetics and lifestyle choices. Diabetes and cardiovascular diseases are prevalent ailments in this community. Nonetheless, healthcare providers fail to recognize the root causes affecting their lifestyle choices and offer no interventions to address them. In an interview with Mary Warren, she highlights that healthcare providers overlook the fact that patients can make changes to their diets and adjust their exercise levels. Mary, herself prefers consuming holistic foods and is convinced that others making a similar switch can reduce the incidence of cardiac diseases. Despite this, when she had a hospital visit, doctors offered no interventions and relied solely on medication as a form of treatment. This has left Mary feeling frustrated, to the extent that she avoids going to doctors altogether.
“They didn’t let us know, because they just assume we’re not gonna do it anyway” (Fret, 2019).
This quote from Mary Warren is a prime example of implicit bias where healthcare providers assume individuals from certain racial or ethnic groups are not motivated to take action or follow medical advice. This lack of trust is rooted in an unfair and prejudiced stereotype, which deprives patients seeking holistic treatment of fair and appropriate healthcare interventions. Patients in the community may not be aware of alternative treatment options available to them. Therefore, it is the responsibility of healthcare professionals to educate and inform them of the available options. However, patients of color often only receive medical interventions and are not offered a comprehensive healthcare approach.
“Race-related attitudes among physicians, even if held implicitly, may influence the quality of communication in patient-physician interactions and thus impact the disparities in treatment and information exchange”(Shen, 2017).
A study investigating the patient-doctor relationship revealed that black patients were more likely to receive inadequate communication from their physicians and were not given the chance to participate in their treatment plans compared to white patients. The study included 10 comparisons of doctors with their white and black patients, and the findings indicated that in half of these comparisons, black patients reported experiencing a lower quality of patient-physician interaction compared to their white counterparts. One patient described feeling disconnected from their treatment process and not being given the opportunity to provide their input. Although findings such as these are often seen with some level of detachment, it’s important to remember that they reflect the experiences of actual individuals, as seen in Mary Warren’s story.
Implicit Bias
Healthcare workers are particularly susceptible to implicit bias, despite their extensive education and apparent lack of overt racism or judgment toward others. Andrea Williams-Morales shares her perspective on the impact of biases on healthcare treatments, highlighting how healthcare providers often fail to recognize the effects of their biases. These biases are so deeply ingrained in the medical community that healthcare professionals may not even realize that they are acting in a biased manner. Studies and data support her statement and have revealed that healthcare providers often unknowingly differ in their diagnoses depending on the race of the patient being treated. A common misbelief in the community is that patients of color can withstand more pain, resulting in physicians administering more aggressive treatments. An example of this is seen in Chapman’s study, where non-white patients were less likely to receive pain medications than their white counterparts. This type of treatment trivializes the pain that individuals may be experiencing and reinforces the notion that their health concerns are not taken seriously. Additionally, the study found that black men are less likely to be prescribed chemotherapy and radiation therapy for prostate cancer and more likely to have their testicles removed (Chapman, 2013). These drastic medical measures stem from the belief that patients of color cannot commit to longer but less extreme treatment options and must instead endure severe treatments. These findings demonstrate the insidious effects of implicit bias in healthcare and highlight the importance of addressing and correcting these biases.
What can be done?
To effectively address healthcare bias in treatment, a comprehensive approach is necessary. While bias training and education programs exist, they may not be sufficient to counter deeply ingrained biases (Takeshita et. al). A critical solution involves increasing diversity among healthcare providers by implementing inclusive hiring practices. A more diverse workforce can reduce implicit biases through increased cultural sensitivity and understanding. Healthcare institutions must establish policies and procedures that ensure equitable treatment for all patients. This includes the implementation of standardized protocols for patient care, establishing clear communication channels between patients and providers, and regularly monitoring and assessing patient outcomes to identify and address disparities. Finally, engaging patients and communities in the design and delivery of healthcare services is essential. This approach can foster patient-centered care and ensure that the unique needs and perspectives of diverse populations are considered.
Citations
Chapman, E.N., Kaatz, A. & Carnes, M. Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities. J Gen Intern Med 28, 1504–1510 (2013).
Fret, Lauren. Interview with Mary Warren. 25 June 2019 (Y-0136). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Hall, William J et al. “Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review.” American Journal of Public Health vol. 105,12 (2015): e60-76.
Katz, Madelaine. Interview with Andrea Williams-Morales. 23 June 2019 (Y-0137). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Shen, Megan, et al. “The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature.” Journal of Racial and Ethnic Health Disparities, vol. 5, no. 1, 2018, p. 117.
Takeshita J, Wang S, Loren AW, et al. “Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings.” JAMA Netw Open. 2020;3(11):e2024583.