Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites

Abstract

Black Americans are systematically undertreated for pain relative to white Americans. We examine whether this racial bias is related to false beliefs about biological differences between blacks and whites (e.g., "black people's skin is thicker than white people's skin"). Study 1 documented these beliefs among white laypersons and revealed that participants who more strongly endorsed false beliefs about biological differences reported lower pain ratings for a black (vs. white) target. Study 2 extended these findings to the medical context and found that half of a sample of white medical students and residents endorsed these beliefs. Moreover, participants who endorsed these beliefs rated the black (vs. white) patient's pain as lower and made less accurate treatment recommendations. Participants who did not endorse these beliefs rated the black (vs. white) patient's pain as higher, but showed no bias in treatment recommendations. These findings suggest that individuals with at least some medical training hold and may use false beliefs about biological differences between blacks and whites to inform medical judgments, which may contribute to racial disparities in pain assessment and treatment.racial bias | pain perception | health care disparities | pain treatment A young man goes to the doctor complaining of severe pain in his back. He expects and trusts that a medical expert, his physician, will assess his pain and prescribe the appropriate treatment to reduce his suffering. After all, a primary goal of health care is to reduce pain and suffering. Whether he receives the standard of care that he expects, however, is likely contingent on his race/ethnicity. Prior research suggests that if he is black, then his pain will likely be underestimated and undertreated compared with if he is white (1-10). The present work investigates one potential factor associated with this racial bias. Specifically, in the present research, we provide evidence that white laypeople and medical students and residents believe that the black body is biologically different-and in many cases, stronger-than the white body. Moreover, we provide evidence that these beliefs are associated with racial bias in perceptions of others' pain, which in turn predict accuracy in pain treatment recommendations. The current work, then, addresses an important social factor that may contribute to racial bias in health and health care.Extant research has shown that, relative to white patients, black patients are less likely to be given pain medications and, if given pain medications, they receive lower quantities (1-10). For example, in a retrospective study, Todd et al. (10) found that black patients were significantly less likely than white patients to receive analgesics for extremity fractures in the emergency room (57% vs. 74%), despite having similar self-reports of pain. This disparity in pain treatment is true even among young children. For instance, a study of nearly one million children diagnosed with appendicitis revealed that, relative to white pa...

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“…According to Hoffman et al 36 , it is possible that the disparity in the use of analgesia according to racial groups is associated with social perceptions based on the existence of intrinsic biological differences concerning pain sensibility. These authors interviewed medical students and residents and found that perspectives they identified as "internalized racism" were common.…”

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“…As the above correlational studies 14,15,21 suggest, it is not clear how much of the "race effect" in physicians' management of patients' pain is due to explicit rather than implicit bias. Explicit bias must be involved to some degree, however, given that the false (and fully conscious) belief among even young physicians and medical students that Blacks are biologically less sensitive to pain than Whites is not rare 21 .…”

“…Explicit bias must be involved to some degree, however, given that the false (and fully conscious) belief among even young physicians and medical students that Blacks are biologically less sensitive to pain than Whites is not rare 21 . On the other hand, if implicit racial bias undercuts racial egalitarian values in physicians' pain management decisions, a recent study by Burgess et al 22 suggests that the high "cognitive load" (i.e., complex, time-pressured decision-making that taxes working memory) physicians routinely carry could create openings for unconscious negative stereotypes of Blacks to influence decisions.…”

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“…For example, folk beliefs about African-Americans and other minorities being less sensitive to pain have persisted since times of slavery, and this belief has been tied to inequities in how pain medication is dispensed in hospital emergency rooms (Hoberman 2012;Hoffman et al 2016). Todd et al (1993Todd et al ( , 2000 found that 55% of Hispanics and 43% of blacks received no pain medication when admitted with long-bone fractures, compared to 26% of whites.…”