In medicine, there exists a dangerous condition that affects millions of Americans each year but is woefully underdiagnosed. It affects how long we live and how much we pay for health care. It impacts the way doctors treat us and care for us. Yet, many health care providers are reluctant to acknowledge that this condition exists.
That condition is bias in medicine.
We know that bias and discrimination kill. In politics, the nation is grappling with an openly biased President and confronting longstanding racial and religious divisions. Countless protests have ignited over police violence and the fight for human rights in America. But a lesser known transgressor is the bias that colors the health care industry.
Consider, for example, the following story:
“I was a medical student on the neurology service at my medical school taking care of a young patient with sickle cell anemia. When I saw her the morning before her discharge, she was in so much sudden pain that she couldn’t walk properly, so I rushed to tell the doctors. My supervising resident dismissed my report, saying something like ‘she’s just faking it.’ And I couldn’t convince them otherwise.
Later that day, we were urgently called to the little girl’s bedside. She had suffered a possible stroke. I will never forget the way her mother cried as her daughter writhed in pain on the bed. Though they never explicitly mentioned race, I will never forget that the doctors didn’t believe a black girl’s pain.”
This harrowing story happened to me — a medical student working with well-intentioned and caring doctors. I’ve tried to reflect on this experience multiple times, searching for an angle where racial bias wasn’t a contributor to this little girl’s fate. Each time, it is impossible for me to conclude that bias didn’t impact care — even though I know the doctors I work with are caring individuals.
Research on bias in medicine shows us that professionals who openly deny their bias can still unknowingly discriminate. Studies show that white doctors with strong unconscious racial bias are less likely to prescribe narcotic pain medications to black patients compared to white patients — even when they feel the same amount of pain. Another revealed that white doctors who denied overt discriminatory beliefs, but who tested for strong unconscious racial beliefs, were rated as delivering less quality care to black patients. Yet another study has also shown that bias worsens the treatment of black patients with heart attacks, who are less likely to be prescribed life-saving heart treatments than white counterparts.
These findings are certainly troubling. But research has also identified strategies for correcting these health care disparities for patients. One strategy is to shed light on these prejudices and acknowledge that anyone can have them. The Implicit Association Test (IAT), developed at Harvard University, helps medical students and doctors identify the racial, gender, religious or disability biases they may unknowingly harbor. The test has been an important tool to identify and measure bias — especially in health care, where providers pride themselves on their perceived impartiality. This screening helps individuals identify the many ways that society’s prejudices have been internalized as our own, even for individuals who believe they are “colorblind.”
Another strategy is to engage in discussion about how bias may affect care. Discussion in a nonjudgmental and understanding manner helps people analyze their bias without becoming defensive or stubborn. Studies have demonstrated that raising awareness pushes biases into conscious awareness — allowing us to wrestle with them before they factor into treatment decisions.
Although raising awareness and engaging in discussion both seem straightforward, the stigma around bias in health care can prevent such engagement. Like many other illnesses, treatment of bias is not very effective without identifying its symptoms and acknowledging its existence.
This is why I choose to share my story and get involved with a student-run advocacy organization about bias in medicine. We labeled our effort Systemic Disease because bias acts like any other illness — taking root and causing symptoms involuntarily while creating lasting damage on people’s health. Our community holds advocacy events and audits bias-reporting systems at medical institutions. Most importantly, it offers a storytelling platform about bias, empowering anyone to share a story or teaching moment about bias in health care — like my own.
At this moment in history, Americans are struggling to face the deep fractures of race, gender, religion and class that divide us. As medical students, we see the effects of these social divisions play out all too often in people’s health. The link between our individual experiences and the structural issues at play inspired us to create an online community to raise awareness about this very important issue.
As we confront social injustice as Americans, it is time that we as health care providers, students and patients do, too.
Sofia Noori is a medical student and contributor to Systemic Disease.
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