The strangest of all encounters: racial and ethnic discrimination in US health care

Abstract

In 2003, a Committee of the Institute of Medicine of the National Academy of Sciences summarized hundreds of studies documenting that US racial minorities, especially African Americans, receive poorer quality health care for a wide variety of conditions than their White counterparts. These racial differences in health care persist after controlling for sociodemographic factors and patients’ ability to pay for care. The Committee concluded that physicians’ unconscious negative stereotypes of African Americans, and perhaps other people of color, likely contribute to these health care disparities. This paper selectively reviews studies published after 2003 on the likely contribution of physicians’ unconscious bias to US health care disparities. All studies used the Implicit Association Test which quantifies the relative speed with which individuals associate positive attributes like “intelligent” with Whites compared to Blacks or Latino/as. In addition to assessing physicians’ unconscious attitudes toward patients, some studies focused on the behavioral and affective dimensions of doctor-patient communication, such as physicians’ “verbal dominance” and whether patients felt respected. Studies reviewed found a “pro-white” unconscious bias in physicians’ attitudes toward and interactions with patients, though some evidence suggests that Black and female physicians may be less prone to such bias. Limited social contact between White physicians and racial/ethnic minorities outside of medical settings, plus severe time pressures physicians often face during encounters with patients who have complex health problems could heighten their susceptibility to unconscious bias.

Predictors of Delayed Emergency Department Throughput Among Blunt Trauma Patients

“…One possible theory is that there is an unconscious provider/ administrative bias toward underinsured patients and decisions surrounding ED disposition may be subject to systemic and unconscious bias present in our medical system. [36][37][38] In fact, disparities between racial and socioeconomic groups have been extensively studied and remain prominent in ED LOS among trauma patients. 35,39 Results from this large nationally representative trauma database poses areas for further study and potential improvement in both hospital and provider level biases.…”

Barriers to Care for Persons With Sickle Cell Disease

“…Both discrimination and unconscious bias persists in our health care system (FitzGerald & Hurst, 2017; James, 2017). Healthcare providers have implicit and explicit racial bias demonstrating positive attitudes towards white persons and negative attitudes towards persons of color (Hall et al, 2015).…”

Group Medical Visits as Participatory Care in Community Health Centers

“…Existing research shows that health care inequalities are reproduced through the interplay of interpersonal, institutional, and structural factors in care delivery. For example, at the interpersonal level, recent research shows that clinician racial bias, whether implicit or explicit, is associated with poor treatment for African American patients (Hoffman, Trawalter, Axt, & Oliver, 2016; James, 2017). At the institutional level, literature describes how the typical structure of medical encounters plays a substantial role in the production of health care inequalities (Cooper & Roter, 2003; Waitzkin, 1993).…”