A hypothetical male patient diagnosed with hypertension served as the starting point for a University of Chicago study on racial bias in health care in the U.S. and France.
American clinicians determined a white version of the patient was more likely to improve his condition and adhere to treatments than a black patient with the exact same medical history, according to the study.
Overall, U.S. clinicians in the study rated white patients as being more personally responsible for their health than black patients. Clinicians in France, researchers found, didn’t exhibit bias toward either race.
“We found in the U.S. that the reason clinicians saw black patients as less likely to improve is because they saw those patients as less personally responsible for their health than their white counterparts,” said Natalia Khosla, a second-year medical student at the University of Chicago and co-author of the study. “Clinicians tended to see black patients as less likely to take responsibility for their health, less likely to follow treatment recommendations and less likely to get better.”
The study surveyed 164 clinicians – 83 in Chicago and 81 in a hospital in Nice, France – by asking doctors, nurses, physician assistants and medical students to read a doctor’s notes about the hypothetical patient. The notes were identical with the exception of race, which was noted as either white or black.
Each clinician read one patient’s history before answering 10 questions, such as “How likely is it the patient’s condition will improve?” and “How likely is it that the patient will take the recommended prescriptions?”
Khosla conducted the research in France while she was an undergraduate student at Yale University, where she majored in psychology and focused on race and gender bias. Khosla’s interest in race and gender bias grew from her own experiences.
“I grew up in a mostly homogenous, conservative mostly white suburb. My parents are from India,” she said. “With that experience early on in school, it made me realize I had to always be thinking about my race even if I had no interest in thinking about it because it came up in my life constantly. ... It felt like a barrier I have to overcome all the time.”
Khosla’s undergraduate thesis on bias in medical settings developed into the paper published April 2 in the journal of Social Science and Medicine.
“We need to continue to examine if medical providers have preferences for some groups over others, either implicit or explicit, and how that affects treatment, expectation for patient success, and interactions with patients,” said co-author Sylvia Perry, an assistant professor of psychology at Northwestern University who was Khosla’s undergraduate thesis advisor at Yale, in a statement.
Medicine is portrayed as being fact-based, objective and free from racial bias and discrimination, Khosla said. But the study “emphasized how much bias works to control behaviors completely within our subconscious,” she said. “Science and medicine are not invulnerable to the effects of racism, because we are humans and are shaped by our environment.”
Khosla sees those implicit biases as a “major barrier to equalizing health outcomes.” She says there needs to be a “culture change” within in the field to accept that clinicians can be subject to bias. “I think the only way to eliminate a problem is to first accept there is a problem and then break down all the barriers to discussing it,” she added. “This makes it even more important that we each take the initiative to reflect on our own bias daily, without putting that onus on the marginalized to point it out to us. And when people do point it out, we must believe them.”
While French clinicians didn’t exhibit racial bias in the study, that doesn’t mean they’re free from bias, according to Khosla. “Bias is constructed by culture,” she said. “There is significant inequality in France and we didn’t pick up on it using these measures, indicating their bias works differently.”
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