Does racial bias compromise patient care?


Recently, Dr. Michelle Herren, a professor of pediatric anesthesiology at the University of Colorado and Denver Health Hospital, resigned after posting racist comments on her Facebook page. In particular, she wrote that Michelle Obama speaks “ebonics” and stated that our first lady has a “monkey face.” Dr. Herren ended her post by affirming that she is not racist but was “just calling it like it is.” This post remained on Facebook for over four days until a patient reported the remarks to the Denver Health board of directors.

Having trained in emergency medicine at Denver Health and the University of Colorado, where I also served as a chief resident, I was obviously shocked by these comments. I couldn’t help but wonder about all the children that Dr. Herren treated over the last nine years at Denver Health, a county hospital serving a large minority population. Did these children always receive adequate anesthesia? Did Dr. Herren’s racial bias compromise patient care?

A recent study in JAMA Pediatrics showed that black children are less likely than white children to receive pain medication in the emergency department when presenting with a diagnosis of appendicitis. This study is not unique. A recent study from the University of Virginia demonstrated that nearly 14 percent of sampled medical students endorsed beliefs that black people feel less pain than white people. Students citing this belief were also less likely to prescribe pain medication to black patients.

While these articles are recent, these disparities in medical care are hardly new. Now as we must ask when will we, as health care providers, demand that the medical community acknowledges the impact of bias, both implicit and overt, on the health care outcomes of our patients and our children. As health care providers, we have all completed mandatory modules on the importance of diversity and cultural competency, and we all know that these perfunctory measures are inadequate. Just checking these boxes does a disservice to our patients and our community. We must demand that medical institutions treat the values of diversity and inclusion as a driver of medical excellence.

How this is executed remains a fertile frontier in medicine and our study of health care outcomes. Possible solutions include additional research on how we can make physicians aware of the implicit biases that we all unknowingly believe. Some emergency rooms have incorporated questions about discrimination on the part of the provider into patient satisfaction surveys. This data is then made available to the provider and department chair. Additionally, further work should propose and evaluate interventions that can be implemented on a systematic level, such as pain management protocols for all patients in the Emergency Room, that can circumvent the bias of individual providers.

The exact path remains unknown. But without change, the inherent bias in our system will only become stronger. We must be vigilant and hold both our medical institutions and ourselves accountable for the inherent bias that remains in our medical system.

Dowin Boatright is a fellow, Robert Wood Johnson Foundation Clinical Scholars Program and a clinical instructor, Yale School of Medicine, New Haven, CT.

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