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 When tested with sample scenarios, most doctors showed some
unconscious racial or social bias, but those biases largely did not
influence their decisions about what care they would give the
fictitious patients.
The study’s lead author told Reuters Health by email that past
research has suggested a connection between unconscious biases and
how patients are treated, so the new results are not definitive.
“We need to do formal observational trials to see what’s happening
in real life and also look at other provider associated mechanisms
such as empathy and mindfulness,” said Dr. Adil Haider of the Center
for Surgery and Public Health at Brigham and Women’s Hospital in
Boston.
He and his colleagues write in JAMA Surgery that gaps do exist
between races in healthcare. For example, black patients are more
likely to die after a traumatic injury than white patients.
For the new study, the researchers had 215 doctors - all normally
involved in trauma care at Johns Hopkins Hospital in Baltimore -
take tests to measure their level of unconscious bias for or against
people of different races and social and economic statuses.
Most participants had measurable amounts of unconscious bias. On
average, they had a moderate amount of racial bias and a strong
preference for higher social class. Scores did not differ among
doctors of different races, ages, medical specialties or training.
Women, however, generally had lower levels of race and class bias
relative to men.
The participating doctors were then asked what their treatment
decisions would be in scenarios about people of different races and
social statuses seeking care for various health problems.
Of 27 possible medical decisions the participants could make about
the scenarios, the researchers initially found three that may have
been affected by unconscious bias.
For example, doctors were less likely to order an imaging test for
patients with sore necks after a motor vehicle accident if the
patient was low in socioeconomic status, compared to a higher-status
patient in similar condition.
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Those links disappeared, though, when the researchers accounted for
other factors that could influence decisions like the doctor's own
age and sex.
The study authors caution that they don’t know if their results
reflect what happens in real life.
A previous study led by Dr. Lisa Cooper of Johns Hopkins Medical
School, one of the new study’s authors, linked unconscious biases
among primary care doctors to their communications with patients. If
true, poor communication may ultimately lead to worse care for
patients, the researchers point out.
Haider said trauma and acute care tends to be formulaic, and that
may limit the impact of bias on medical decisions. Those biases may
play a larger role, he added, in situations that require
understanding and partnership between doctors and patients, such as
managing a chronic condition like diabetes.
In addition to observing real-life interactions, “we need to figure
out how to better communicate with all patients, who now are more
and more diverse,” Haider said.
"We need to develop skills so that we can provide the best possible
care to all patients no matter what their (socioeconomic) status is
or where they come from," he said.
SOURCE: http://bit.ly/1CvXTKt
JAMA Surgery, online March 18, 2015.
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