Medical Providers’ Biases

Medical Providers’ Biases

No one should ever receive a poor standard of medical care for any reason, nevertheless implicit associations held knowingly or unknowingly, may influence everyone’s judgment from intake to treatment in the field of medicine, thus creating bias (FitzGerald & Hurst, 2017). The term bias is used to explain both implicit stereotypes as well as prejudices, the presence of which creates serious, possible life threatening consequences for patients. According to psychologist’s bias is the negative assessment of one group and its members compared to another (Kite & Whitley, 2016), and these negative assessments can be based on personal or the retelling of another’s experiences.  Prejudice and stereotyping based on age, gender, socioeconomic status, national origin, religion, color, mental health status, and perceived political persuasion has been built into the fabric of the United States since it’s founding.

When considering healthcare providers it is important to remember that they are tasked with providing impartial, evidence-based care.  Upon graduation they take a Hippocratic oath in which they swear to uphold several principles of medical ethics that remain of paramount significance today. These include the principles of medical confidentiality and non-maleficence.  This implies that those in this profession need to be especially wary of any negative evaluation made that is connected to a patient’s membership in a group or having certain characteristics (Chapman et al., 2013). They are also required to meet performance markers envisioned to produce equal high- quality medical care for all; although much effort is made towards ensuring each and every patient receives proper medical care there are still glaring disparities. The saturation of cultural stereotypes in our society about different groups means implicit bias among doctors can and does affect their clinical decisions that increases health care discrepancies for many.

Current research evidence shows that doctors and nurses develop and hold biases at a similar rate and level as the general population (FitzGerald & Hurst, 2017). According to this body of work race, gender and age tend to be the primary aspects that most individuals use to organize information about others, this information is likely to be the first aspects that people notice about others and these quick judgments often lead to stereotyping.

In one of the vignettes used to extrapolate evidence FitzGerald & Hurst noted a clear link a link between levels of bias and over diagnosis of mental illness in patients specifically when diagnosing depression. The vignette showed a correlation between socioeconomic status (SES) and race.  Some doctors in the study estimated that the blacks had a lower SES and they were diagnosed less with depression as whites. Other physicians tend to estimate a patients SES based on certain demeanor showing a lower SES was linked to patients with a perceived hostile demeanor.  Their research also showed that women were more likely to be diagnosed with depression compared to men.   In another vignette the evidence showed a that Black and Latina women perceived to have a low SES had a higher probability of recommendation for the use of intrauterine contraception compared to a similar group of White women (FitzGerald & Hurst 2017).

This same research showed the existence of bias in the providing of medical care. According to the study, “racism played a higher than average role in the healthcare delivery system”(2017), which is something I see anecdotally when in any medical waiting room but especially in the Emergency department. It is important to the reader to understand that underserved populations, especially people of color, are less likely to seek medical attention regardless of economic status. According to FitzGerald & Hurst this shows a clear relational role in healthcare provision (FitzGerald & Hurst, 2017).   In my reading of the research it seems clear that the resistance of people of color to seek medical attention is correlated to past experiences or the experiences of others when medical treatment was sought out.

There is medical data that in comparison black women are less likely to have breast cancer than white women, however, when the mortality rate is measured instead the data show clearly that the death rate from breast cancer is higher in comparison between black women and white women. This discrepancy is either a result of them not seeking care, less access to care, or misdiagnosis of condition (Chapman et al., 2013).  This correlation is also shown in the percentages of complicated births. It is striking that black women with college degrees have a statistically higher percentage of complications during childbirth compared to white women who do not have a college degree. Again race and SES are the particular factors linked to the delivery of healthcare. When a doctor meets with any patient, the quality of healthcare provided is immeasurable and in these specific cases, it is imperative doctors ensure that the quality of care offered matches the needs of the patient regardless of any socially normed factors.

When physicians make medical decisions rooted in biases it may minimally cause misunderstanding and misdiagnosis, at worst denial of early treatment leading to death (Chapman et al., 2013). In another anecdotal experience a highly educated black woman was ultimately diagnosed with Thyroid cancer with two masses, one wrapped around her esophagus but the process to get the correct diagnosis and treatment took 2 years of her going to her primary doctor to be told the test results were within “normal limits”; because this woman understood the value of persistence and how to leverage her education, she self-referred to an Endocrinologist who ordered the correct test and within a week gave the correct diagnosis.

In the research of Chapman it was demonstrated that physicians tend to be biased when diagnosing women. He looked at the rate of misdiagnosis with black female teenagers in urban communities; it was the various doctors’ biases about cities and those that live there that led to the significantly higher rate of misdiagnosis. It may be necessary for a directed increase in diversity markers in medicine personnel to minimize the effect of bias on the care of patients, whether that allows for better informal peer to peer discussions or more formal cultural competency training it is important for practitioners come from multiple diverse groups.

 In many cases, people of color are less likely to receive high quality health care compared to white patients. They may be denied procedures, tests, or treatments because of a perceived lack of funds on the part of the practitioner (Blair et al., 2011). Research also shows that white physicians have a higher instance of avoidance to caring for a black patient due to their own fear or discomfort. Other doctors argue that they ‘lack experience’ working with black people; hence, they avoid handling the cases. Studies show that people of color in emergency rooms are less likely to receive prescription analgesics compared to whites. Yet another study showed that Hispanic patients, specifically, are less likely to receive opioids compared to non-Hispanic patients. The data of research continue to show the existence of bias in medical care and specifically the emergency department and physicians tend to disagree with each other during consults when it comes to caring for patients from a race other than their own.