Doctors’ unconscious racial biases leave patients dissatisfied

A key step in reducing racial health care disparities is for physicians to be aware that many people, including doctors, have unconscious biases, said the lead author of a recent study.

“As physicians, we like to believe that we are not biased, and on a conscious level, we’re not,” said Lisa A. Cooper, MD, MPH, professor in the division of general internal medicine at Johns Hopkins University School of Medicine in Baltimore. “But I want people to realize that unconscious biases exist and can have a negative effect on how we interact with patients.”

Primary care physicians with such attitudes tend to dominate conversations with black patients during routine visits and pay less attention to their social and emotional needs, according to a study published online March 15 in theAmerican Journal of Public Health. Dr. Cooper is the lead author of the study.

The result is that black patients often feel less involved in decision-making related to their health than other patients, the study said. Blacks whose doctors have an unconscious bias also reported reduced trust in their physician, less respectful treatment and a lower likelihood of recommending the physician to a friend.

“The first step [in remedying the problem] is to admit that we’re not perfect,” said Cedric M. Bright, MD, president of the National Medical Assn., which represents black physicians and their patients. “The second is to give ourselves exposure to people of different backgrounds and cultures that enables us to have a better understanding of the differences among people.”

Researchers examined audio recordings of interactions among 40 health care professionals and 269 patients 18 and older in community-based medical practices in Baltimore. The visits occurred between January 2002 and August 2006. The health professionals were mostly family doctors and internists, but four nurse practitioners also were included in the study.

Forty-eight percent of the health professionals were white, 22% were black and 30% were Asian. White and Asian professionals had more pro-white attitudes, and black professionals had mostly neutral attitudes toward all patients.

Measuring unconscious biases

Researchers assessed health professionals’ unconscious attitudes about race using two versions of the Implicit Association Test. The computer-based tool measures how quickly a participant associates good or bad words with people from each race. If an individual is quicker at associating the good words with a particular race, that person is considered to have a subconscious preference toward that race.

One test asked participants to associate generic positive terms and negative words with people from each race. For the second test, physicians assigned to each race words representing medical compliance and reluctance. Researchers analyzed the audio recordings and issued patients a questionnaire after their appointment.

The study showed that the doctors overall had a moderate implicit bias against blacks and a stronger association of whites with compliance. But no overt bias was detected among the physicians (link).

Doctors who unconsciously thought blacks are less likely to be compliant than whites had longer office visits with black patients and spoke more slowly to them, the study said. As a result, black patients reported lower levels of trust and confidence in such physicians.