Racial Bias in Medicine: Is the U.S. Healthcare System Working For (or Against) Your Patients?

The coronavirus has taken a significant toll on the black community, as we’ve reported here at Scrubs Mag. In some areas, African Americans are around three times as likely to die from the diseases known as COVID-19 as white Americans. They are also more likely to suffer from chronic diseases such as asthma, diabetes, and hypertension, all of which can exacerbate the effects of the virus.

Health experts believe there are many reasons for this. Black Americans are more likely to work essential jobs that can put them in harm’s way during the pandemic, such as healthcare, janitorial work, essential retail, and other industries. They are also more likely to take public transportation and live in crowded urban settings, which can increase the risk of infection.

However, racism in healthcare started long before the coronavirus pandemic. Find out how your facility may be unintentionally discriminating against black patients, and what you can do about it.

Racial Health Inequalities in America

Studies show that black Americans are less likely to receive preventative medical care, such as early cancer screenings, regular physicals, and wellness checkups. Over the last few decades, mortality rates have decreased for many chronic conditions across all ethnic groups, but the gap between black and white Americans has only gotten worse.

Studies also show that black Americans tend to receive lower-quality care when they do go to the doctor’s office or hospital. This may be due to implicit bias among healthcare providers, organizational structures that tend to favor wealthier patients, and other social and economic factors.

According to the American Association of Medical Colleges, half of white medical trainees believe harmful myths, such as black people have thicker skin or less sensitive nerve endings than white people. White physicians and doctors are less likely to diagnose and treat a black person’s pain than they would for a white person. This can lead some African Americans to distrust the medical system, believing that their doctor or nurse doesn’t take their concerns seriously.

The study makes it clear that these disparities are not the result of malicious intent. Instead, it lays the blame on “complex influences,” arguing that, in most cases, providers were not even aware they were discriminating against black patients.

Is Technology Making the Problem Worse?   

Technology is rapidly changing the field of medicine. Many hospitals and doctor’s offices now rely on complex algorithms when recommending and assigning treatment to patients. These algorithms are meant to supplement the doctor’s medical opinion, not replace it.

One algorithm, in particular, is used to manage care for around 200 million patients across the U.S. A rare study of the program shows that these equations are making the problem of racial discrimination worse. The study was considered rare since researchers don’t often have access to the inner workings of these programs. They often contain sensitive, private medical information that must be handled with care.

The algorithm is used to determine whether a patient should receive additional, customized medical healthcare. Based on the results of the study, the program decided that just 17.7% of black patients needed additional medical care. Researchers believe that if they were to remove any bias in the program, that number should have been closer to 46.5%.

So, how did this algorithm get so biased?

Researchers discovered that the algorithm based its decision on just one factor: the total cost of care the patient has already received. The designers of the program believed that this was a reliable factor for assigning additional care. Their thinking was the sicker the patient, the more care they would have already received, but that’s not always how the world works.

Many black patients who participated in the study were considered just as sick as their white counterparts, but they did not go on to receive additional treatment because they hadn’t received as much care beforehand.

However, the program fails to consider the many structural, economic, and educational factors that are at play when it comes to receiving medical care. Some of these black patients may not have known they were sick. They may have missed important screenings and appointments along the way that ultimately contributed to the algorithm’s diagnosis.

Researchers were able to reduce bias by 84% by introducing new variables into the program, so the algorithm then based its decision on more than just how much care the patient had received prior.

How You Can Make a Difference

There are lots of ways you or your facility may be unintentionally discriminating against patients who identify as black. Researchers are quick to point out that the best way to counter these trends is for providers and institutions to recognize that race and racism are inherently a problem in the U.S. healthcare system. Doctors, nurses, and other medical staff should keep these inequities in mind when treating black patients, so they can seek out problems and diseases they might normally miss.

It’s also important for providers and institutions to supplement, or rework, statistical algorithms that can contribute to racial bias. They should test out these programs before implementing them in the field to make sure they treat all patients equally, regardless of the color of their skin.

Relying on individual instincts isn’t always the right answer when it comes to improving patient outcomes and reducing bias. Individuals can be just as susceptible to implicit bias as machines, whether they realize it or not. That’s why it’s best to create a system-wide program for treating and diagnosing pain and disease, so providers do not have to make decisions on the fly.

Institutions should also make a point to regularly analyze their patient records to make sure they are treating patients equally. They should work to address societal issues that can affect public health, such as homelessness, lack of transportation, systemic violence, police brutality, and a lack of health education.

Incoming providers and medical trainees should receive implicit bias training, so they can prevent these kinds of racial inequalities going forward.

Overcoming Patient Distrust

Studies have shown that African Americans are more likely to distrust their doctor or primary care provider, regardless of their ethnicity. As a provider, if you suspect that one of your patients does not trust what you’re saying, use these tips to improve communication:

• Be sure to clearly explain how you made your decision, what the patient should do next, and how you can help. Try to personalize this experience as much as possible, so the patient feels seen and heard. Studies show that the more providers personalize the patient experience, the better off the patient will be.
• Talk to the patient about certain obstacles in seeking medical care, such as juggling work and family, lack of transportation, and limited internet access. Look for solutions that work for both parties.
• Instead of handing your patients a pamphlet or book on a disease or condition, sit down and clearly explain this information, including the risks of not following through with appointments and check-ups, how to help patients reduce their risk of getting sick, and other lifestyle factors that can affect their health.

Use this information to make sure all your patients receive the same level and quality of care.