Newswise — A sophisticated cognitive test suggests that physicians—like society at large—hold subconscious racial attitudes and stereotypes, which may contribute to racial disparities in medical treatment, reports a study in the July issue of Medical Care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
The new study—only the second to use the test of subconscious bias in doctors—suggests that pediatricians have less "implicit race bias" than physicians in other specialties and the general public and that there was no relationship between subconscious bias and quality of care. "Further research is needed to explore whether physician implicit attitudes and stereotypes about race predict quality of care," according to the new study by Janice A. Sabin, PhD, MSW, and colleagues of University of Washington, Seattle.
Ninety-five pediatricians took an Internet survey called the Race Attitude Implicit Association Test (IAT). The test measures subconscious attitudes and stereotypes, based on how quickly the user makes connections between race and certain "good" versus "bad" concepts. Previous research in more than 1 million Internet users suggest that most people have some degree of "implicit preference" for whites relative to blacks—generally despite a lack of conscious (explicit) bias or prejudice.
Subconscious Bias Is Present, but Lower in PediatriciansThe pediatricians in the study also showed an implicit preference for whites. However, in this group of doctors—who worked at a large urban medical center—the subconscious bias was weaker than in the general population of Internet respondents. The pediatricians' implicit bias was also weaker than that found in a previous study of emergency room doctors. (That report, published last year in the Journal of General Internal Medicine, was the first study to use the Race Attitude IAT to test implicit bias in physicians.)
The pediatricians actually expressed an explicit attitude in favor of African-Americans. However, in addition to their implicit preference for whites, they held a subconscious bias that white patients would be more compliant (co-operative) with medical treatment. Surprisingly, there was also an implicit link between black patients and receiving "preferred" (as opposed to "adequate") medical care.
The pediatricians were also presented with hypothetical case vignettes of white or black children with common medical problems and asked what treatment they would recommend. Only one of the four vignettes showed a significant racial difference between the treatment recommendations (a higher hospitalization rate for white children with urinary tract infections). This lack of evidence that implicit bias affects medical treatment was in contrast to the study of emergency room doctors, in which the recommended treatments for suspected heart attack were less aggressive when the patient was black.
Many studies have shown racial and ethnic disparities in medical care that are not explained by other factors, such as income or access to health care. Researchers are interested in knowing whether bias on the part of health care providers could help to explain these racial/ethnic discrepancies. Some commentators have suggested that unconscious bias might be a more important factor than overt prejudice.
Much More Research NeededThe new study has some key limitations; the number of pediatricians taking the IAT was relatively small, and they were not a representative sample. However, the study provides intriguing clues for further research, including the possibility that implicit bias may vary among different groups of health care providers.
Like the previous study, it suggests that doctors may have an implicit association with black patients as less compliant with medical care, which might affect their treatment recommendations in various ways. "Future research is needed to gain a better understanding of the complex psychological interactions that exist between physician implicit and explicit attitudes and stereotypes about race, physician perceptions of patient characteristics, physician characteristics, organizational characteristics and quality of medical care," Dr. Sabin and coauthors conclude.
"The IAT is an emerging technique for investigating potential subconscious bias in the medical care setting," comments Dr Jeroan J. Allison of University of Alabama-Birmingham, Co-Editor-in-Chief of Medical Care. "The number of studies is limited and the current study has its own limitations. However, the initial findings are provocative though tentative: unconscious racial bias may impact decisions physicians make about patient care." About Medical CareRated as one of the top ten journals in health services research and healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association. Visit the journal website at http://www.lww-medicalcare.com.
About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (www.LWW.com) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services. LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
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