Patient bias may endanger both physicians of today and the future

The truth is: While physicians are not allowed to discriminate against their patients, patients are allowed to discriminate against their physicians.

This is particularly true in the private sector, fueled by online physician profiles permitting patients to choose provider characteristics ranging from those as benign as Ivy League training background to those as problematic as racial ethnicity. In this setting, the U.S.’s free-market economy reigns supreme — freedom of choice is everything. However, in the public sector, where large academic institutions reside, things should be different.

My fear is that in the current political climate, where prejudice is not only more rampant but more easily accepted, that patient bias may endanger both physicians of today and the future.

One example of the longstanding impact patient bias can have on medicine is seen in obstetrics and gynecology with the demographic shift towards female providers.

Some women prefer to be treated by female providers, and this seems reasonable to many. However, this was not always the case. Fifty years ago, 90% of OB/GYNs were men, and most women did not even have the choice to request a female physician.

As patient bias turned away from male providers, the entire socio-demographic makeup of the field began to change. In 2017, a study published by the American College of Gynecology (ACOG) found that roughly 59% of OB/GYNs were women with projections as high as 66% in the next decade — a sharp contrast to reports half a century prior. Here, patient bias had an overwhelmingly positive impact on the socio-demographic breakdown of the field, with the specialty becoming one of the most diverse in modern medicine over the past few decades.

Some critics have argued for more male representation, while their counterparts believe it is a natural response to years of women and minorities being excluded from the field. Ultimately, patient bias has a profound impact on not only how medicine is practiced but also how it looks to the average patient.

It is important to direct attention to the current state of permissible patient bias and discrimination in medicine.

A recent Medscape publication on abusive patient remarks to providers over five years reports that 31% of physicians have had patients who requested another physician — most often due to one’s gender, ethnicity, or race.

It is no surprise that minority physicians face these challenges at heightened rates, with 70% of African Americans and 69% of Asian Americans reporting biased comments from patients.

A part of me believes this comes down to a certain level of classism that goes uncharted in medicine.

High-income, less-diverse patients have more choice than lower-income patients in the hospital setting — often hiring private consultants directing them on which providers to involve in their care.

Lower-income minority patients, on the other hand, do not have the same power to speak up about what physicians they want included in their care; they must rely on the service physicians provided by the hospital.

Bias in medicine should only be permissible if it is balanced. Minority patients do not have the same authority in the hospital to request minority physicians that unequally places the negative burden of patient selection, discrimination, and bias on those groups.

In large academic hospitals, the art and science of medicine conduct a delicate balancing act.

Academic hospitals generate recognition through scientific discovery and education, “the science,” while dedicated, selfless physicians collaborate with their patients to tackle illness and disease in a clinical setting, “the art.”

The interplay between the micro and macro, the art and science, is crucial to the cogwheel that is academic medicine.

I would urge patients to think critically about the choices they make at their doctor’s office and how their bias and desire for personal comfort can have a longstanding impact on the future of medicine — conceivably disqualifying those who can add to scientific breakthrough so paramount to modern medical treatment.

To physicians, let this be a reminder that while patient bias is occasionally warranted, it is altogether imperfect and unbalanced in the context of our health care system and society at large — often putting a strain on our colleagues who have also suffered for the right to be called “doctor.”

Olamide Omidele is a medical student.

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