The Elephant in the Room: Race and Discrimination Thoughts on Implicit Bias

As the country and the population becomes more diverse, society in general has become more stratified and many of communities have become marginalized.  The healthcare industry isn’t immune to the effects of this stratification and marginalization.  I live in a city where implicit bias is built into the healthcare system and you probably do too. Implicit bias occurs when your brain automatically processes information that is influenced by stereotypes which impact your actions and judgements. Not all disparity is based in race. Implicit bias is affected by your gender, sexual identity, socioeconomic status, educational level, age, disability, and geographic location.

How is a healthcare system with unconscious bias built? It’s simple actually. You divide the patients into those who can pay, and those who need assistance. Then the physicians are divided into those who work at the facilities where patients can pay and those who work at the facilities where patients need assistance.  Even the level of the healthcare coverage you have as a patient can be an influence on how much healthcare resources you get approved to consume.

It is a documented fact that minority groups in this country experience more illness, worse outcomes and premature death as compared to Caucasians.  These discrepancies were first reported in the 1980’s and even though there has been some improvement, it still exists.

A recent complaint from a patient in an emergency room visit proclaimed that the physician and the healthcare personnel treated her as if she was trying to “game” the system to get pain meds. She was in pain but received no diagnostic treatment and was sent on her way posthaste. She stated that she believed this occurred because she was black.

She is an older, church going lady who has no history of drug abuse and she did get help and appropriate care somewhere else. But, she’s probably right.

Some stereotypes that influence our thoughts are:

  • Women are worse drivers than men
  • Asian people are all good at math
  • Women like to talk more than men
  • Black people are athletic

But the unconscious bias is available in many different forms.  Patients have implicit bias against physicians they see as different or fitting a stereotype. Women physicians who wear a headscarf for religious reasons report being questioned, insulted and even attacked by patients. Articles with headlines promising guidelines for dealing with racist patients are appearing in the medical journals.  These guidelines extend to interacting with the patient’s family who are racist and discriminatory. Trainees sometimes are on the front line and absorb much of the abuse.

Every patient and every healthcare professional deserve to be treated with dignity and respect. This should be everyone’s fight. It doesn’t seem respectful that the type or amount of care a person receives is determined by their socioeconomic status.  It doesn’t seem fair that if you are diagnosed with cancer and you want to live then you should be ready to take out a loan or sell your home just to afford treatment.

If you live in a large inner-city area, the only hospital that will be available will be a teaching hospital where the medical schools are providing the major amount of the staff.  The hospitals for the insured populations have moved to the suburbs and outlying areas where the new construction has infused the neighborhoods with people who are insured by their employers.  This gives a whole new meaning to Urban Flight.

The experts say that if you know that implicit bias influences your decisions, you have made the first step in correction. There should be a call to action for all of us to address the racism and discrimination that exists in medicine for both patients and providers.


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