General practice and ethnicity: an experimental study of doctoring

Abstract

BackgroundThere is extensive evidence of health inequality across ethnic groups. Inequity is a complex social phenomenon involving several underlying factors, including ethnic discrimination. In the field of health care, it has been established that ethnic discrimination stems partially from bias or prejudice on the part of doctors. Indeed, it has been hypothesized that patient ethnicity may affect doctors’ social cognition, thus modifying their social interactions and decision-making processes. General practitioners (GPs) are the primary access point to health care for ethnic minority groups. In this study, we examine whether patient ethnicity affects the relational and decisional features of doctoring.MethodsThe sample was made up of 171 Belgian GPs, who were each randomly allocated to one of two experimental conditions. One group were given a hypertension vignette case with a Belgian patient (non-minority patient), while the other group were given a hypertension vignette case with a Moroccan patient (minority patient). We evaluated the time devoted by GPs to examining medical history; time devoted by GPs to examining socio-relational history; cardiovascular risk assessments by GPs; electrocardiogram (ECG) recommendations by GPs, and drug prescriptions by GPs.ResultsWe observed that for ethnic minority patients, GPs prescribed more drugs and devoted less time to examining socio-relational history. Neither cardiovascular risk assessments nor ECG recommendations were affected by patient ethnicity. GPs who were very busy devoted less time to examining medical history when dealing with minority patients.ConclusionsWe found no evidence that GPs discriminated against ethnic minority patients when it came to medical decisions. However, our study did identify a risk of drugs being used inappropriately in some ethnic-specific encounters. We also observed that, with ethnic minority patients, GPs engage less in the relational dimension of doctoring, particularly when working within a demanding environment. In general practice, the quality of the relationship between doctor and patient is an essential component of the effective management of chronic illness. Our research highlights the complexity of ethnic discrimination in general practice, and the need for further studies.

Unintentional Discrimination Against Patients with a Migration Background by General Practitioners in Mental Health Management: An Experimental Study

“…We therefore conclude that there is a significant association between migration status and medical decisions. These differences are consistent with previous studies that also found that medical decisions were affected by a patient’s ethnic background (Centola et al, 2021 ; Lepièce et al, 2014 ). Indeed, providers’ biases have already led to the unsafe undertreatment of migrant patients (Centola et al, 2021 ).…”

“…First, we asked them what type of treatment they would prescribe, providing three different options: non-medical treatment, medical treatment, or a combination of both. Then, we asked those who had prescribed medical treatment or a combination of both if they would prescribe benzodiazepines (i.e., hypnotics, sedatives, and anxiolytics), because literature shows that GPs prescribe drugs more often to ethnic minority patients (Lepièce et al, 2014 ). Finally, we surveyed how likely the GP respondents were to refer the patient, also using the 4-point Likert scale.…”

“…Migrant populations experience discrimination more frequently, which constitutes an additional mental health risk factor (Levecque et al, 2009 ; Missinne & Bracke, 2012 ). Although mental health problems are often identified by primary healthcare services, some studies, however, have shown that general practitioners’ (GPs’) therapeutic decisions regarding patients with a migration background are suboptimal: breakdowns in communication and in the relationship between a migrant patient and a GP can be a frequent source of misunderstanding, the time devoted to a consultation is often shorter for migrants, and GPs’ diagnostic, treatment and referral decisions are sometimes biased by their behaviours and beliefs of migrant patients (Gaya-Sancho et al, 2021 ; Lepièce et al, 2014 ; Shannon et al, 2016 ).…”

“…GPs’ beliefs can lead to unintentional discrimination (i.e., unjustifiable differential treatment) against migrant patients with mental health problems. GPs’ decisions are sometimes based on situational context, level of prejudice, cognitive busyness, training, time pressure, implicit/explicit ethnic biases, and their experience of intercultural contact (Gopal et al, 2020 ; Kite & Whitley, 2016 ; Lepièce et al, 2014 ). Poor humanization in care may strengthen these biases.…”

Unconscious Bias among Health Professionals: A Scoping Review

“…Four studies assessed more than one race. One study [ 82 ] assessed the biases of local (European) general practitioners against individuals with migrant status compared to local people using a foreign (Moroccan) vs. a typical local (Belgian) name. No study investigated bias against Asian people or people from other racial or ethnic backgrounds.…”