The recent pandemic has shown that African Americans have not fared well in the medical system. Blacks have had 35% of deaths, while only comprising 13.4% of the US population. With those statistics, some may even say the medical system has failed them.
Every year, upward of 12 million Americans see a physician and come away with a wrong diagnosis. Nearly 1/3 of those are African American. So, could it be just bad judgement? Maybe missing facts? Or could it be something more?
The Johns Hopkins Armstrong Institute for Patient Safety and Quality’s Center for Diagnostic Excellence found that judgment errors accounted for 86 percent of 55,377 medical malpractice claims he evaluated where misdiagnosis led to death or disability. The judgment blame bucket includes an assortment of knowledge gaps, inattentions, misinterpretations and what many are seeing now: implicit bias.
Implicit bias occurs when a well-intended physician’s unconscious assumptions get in the way of objectively gathering or assessing a patient.
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Some Black patients complain of:
- Patients of other races receiving better treatment
- Rushed/Less time in doctor visits
- Confusing/Conflicting diagnoses
- Doctors less likely to agree with second opinions
Dr. Elizabeth Chapman, assistant professor of medicine at the University of Wisconsin, wrote in the Journal of General Internal Medicine that implicit bias among physicians impacts clinical decision-making that perpetuates disparities, even when they strive to deliver equal care. Her research showed that unconscious judgments built on negative stereotypes affects diagnosis, treatment and patient follow-up.
Gender disparity in healthcare is also an issue. One study, published in BMJ Open, reported women were significantly more likely to require three or more pre-referrals before they obtained a consultation for bladder or kidney malignancy as compared to men.
So what causes this bias?
While some believe it's just biases passed down from generation to generation without anyone checking them. Others believe that physician burnout may have a part to play as well. Or at least it shows how much more biased they really are.
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Physician burnout among resident physicians could potentially be linked to racial bias, according to the results of a 2017 study published in Jama Network Open. For the study, researchers drew from a national sample of nearly 3,400 non-black, second-year residents and asked questions about their racial beliefs and if they experienced burnout symptoms.
Nearly half of respondents reported they experienced burnout symptoms, which include emotional exhaustion, negativity, and depression.
These results were compared with their feelings toward African Americans, which were calculated using a ‘feeling thermometer’ where participants gauged their racial beliefs on a scale from 1 to 100. Participants were also instructed to sort pictures of black and white individuals into groups that were labeled either ‘good’ or ‘bad’.
“Overall, resident physicians who had at least 1 symptom of burnout had lower mean scores toward black people compared with those without symptoms of burnout,” the researchers write. “Higher emotional exhaustion and depersonalization scores were associated with more unfavorable attitudes toward black people.”
These results suggest that black patients may not be receiving the same level of care that white patients receive, further widening the racial gap in the United States.
So how can you tell if your doctor is biased?
In addition to doing your research on your physician, looking and asking for reviews, and seeking second and even third opinions, you can ask your doctor these questions:
- What do you think is causing my problem?
- Is there more than one condition (disease) that could be causing my problem?
- What tests will you do to diagnose the problem and which of the conditions is present?
- How good are the tests for diagnosing the problem and the conditions?
- How safe are the tests?
- If you are wrong about the diagnosis, how will we know?
Here are further queries that can help to minimize misdiagnosis that occurs as a result of anchoring and diagnostic momentum:
- If we are not getting results, should we consider another approach?
- I know you think I have “x”, but how can you tell if it’s not “x”?
- How long do you expect it to take for the treatment to start working?
- How will we know if the treatment is working?
- I know that Dr. X said “y” but could she be wrong?
