A Systematic Review of the Extent and Measurement of Healthcare Provider Racism

Abstract

Despite burgeoning interest in racism as a contributor to racial disparities in healthcare, we still know little about the extent of healthcare provider racism or how best to measure it. Studies using more sophisticated approaches to assess healthcare provider racism are required to inform interventions aimed at reducing racial disparities in health.

Racial, Gender, and Socioeconomic Status Bias in Senior Medical Student Clinical Decision-Making: A National Survey

“…Although our study had none of the quality flaws noted in a recent systematic review of research on racial bias in health care practitioners, 11 it does have several potential limitations. It is possible that our efforts at blinding students to our interest in stereotyping in decision-making were not successful, and as a result, our findings are not valid representations of the students' true decision-making tendencies.…”

“…1 However, there is evidence that stereotyping or decisional biases by clinicians in some situations may also play a role. [1][2][3][4][5][6][7][8][9][10][11][12] For example, Schulman, et al found that recommendations among practicing clinicians for standardized video vignette patients presenting with cardiac symptoms varied according to patient race and gender. 13 Another study showed variations by patient race and socioeconomic status in clinician expectations of post-angiogram cardiac patients.…”

Editor's Spotlight/Take 5: Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial

“…Are these usage differences caused by impediments to access and provider prejudices, or are they the result of valid personal decisions made by patients who may be caregivers for others or primary wage-earners? Might these differences be explained by patients' perceptions of discrimination [2,21] or by lower levels of trust in a healthcare system that in fact has not always treated all patients equally [5,18]? Such questions should matter to all of us, regardless of the particular type of surgery each of us might perform.…”

Capsule Commentary on Paradies et al., ‘A Systematic Review of the Extent and Measurement of Healthcare Provider Racism’

“…2 Discrimination research has emphasized that bias has a broader context that is not limited to interpersonal factors or encounters but also includes institutional, historic, and socially determined components with complex interplay in how individuals experience, internalize and react to bias. 3,4 As healthcare providers we want to believe that bias is not something we do and has led to the 'not-me-phenomenon,' referring to clinician beliefs that disparities do exist but not in their own clinical practices. Unfortunately, prior research has demonstrated that physicians do have unconscious beliefs and behaviors that influence the clinical encounter through communication, evaluation and treatment decisions with lasting effects on patient morbidity and mortality.…”

“…[1][2][3] In this issue of JGIM, Pardies et al present an important contribution to the discrimination research literature by focusing on provider bias. 4 The article provides a thorough review between 1995 and 2012 including international studies, thus updating and expanding prior reviews. This article highlights several key areas for future research: the need to use multidimensional bias measurement scales; study of other bias-mediating emotions and attitudes (i.e., trust); undertaking longitudinal studies; studying all categories of healthcare providers, not just physicians; and developing interventions that address bias.…”