How Doctors Can Confront Racial Bias in Medicine

http://www.scientificamerican.com/article/how-doctors-can-confront-racial-bias-in-medicine/?WT.mc_id=SA_SP_20151026

By Rachel Pearson | Oct 20, 2015

Medicine has a race problem. Doctors consistently provide worse care to people of color, particularly African-Americans and Latinos. In studies that control for socioeconomic status and access to care, researchers have found racial disparities in the quality of care across a wide range of diseases: asthma, heart attack, diabetes and prenatal care, to name a few. Two studies performed in emergency rooms showed that doctors were far more likely to fail to order pain medication for black and Hispanic patients who came in with bone fractures. Doctors are less likely to diagnose black patients with depression yet more likely to diagnose psychotic disorders such as schizophrenia. Hispanic HIV patients are twice as likely to die as white HIV patients, and black HIV patients are less likely to get antibiotics to prevent pneumonia. There is, however, one procedure that doctors are more likely to perform on black patients: amputation.

As a medical humanities M.D./Ph.D. student, I set out to understand how my profession, which prides itself on objectivity, could be influenced by something so subjective and harmful as racial bias. I found part of the answer in the kind of objectivity that doctors value. As trainees, we aspire to be like scientists, who see the self as a potential source of error and therefore try to suppress it. But medicine is not a science—it is a moral practice that uses science. When problematic parts of ourselves, such as racial bias, intrude, we find it hard to recognize the problem.

In studying memoirs of medical students and residents, I found that many trainees feel an acute anxiety about the self. When we react emotionally to intense situations, we worry that we are not being good doctors. When we do not react—when we coolly watch a patient die or approach a critically ill child with clinical detachment—we worry that we are becoming monsters. We are unsure of the role emotions should play in clinical care. Interestingly, one specific emotion—discomfort—is thought to underlie disparities in care. Feeling uncomfortable, we rush out of encounters with patients of other races.

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If white medical trainees avoid talking about race except as a biological fact, how can we explore racial bias? We might begin by revising our model of objectivity. Doctors are always themselves—emotional, particular and sometimes biased—in the hospital. We should accept this fact and learn to work with it. We should train ourselves, for example, to notice our own discomfort and respond by slowing down instead of rushing out of patient encounters. (Some medical schools are now training students to do just that.)

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