BALTIMORE—New Johns Hopkins research shows that medical students have unconscious if not overt preferences for white people, but this innate bias does not appear to translate into different or lesser healthcare of other races.
The research findings, published in the Sept. 7 issue of the Journal of the American Medical Association, questions whether something could be happening during medical training that turns benign unconscious preferences of students into ideas and behaviors that may lead to different types care for patients of different races.
Being a member of a minority race and being poor are consistent predictors of worse health outcomes in the United States, the investigators say, and substantial amounts of research suggest that racial bias—conscious or not—is an important factor in clinical decisions that create racial disparities in healthcare.
“Our results raise the question: Are we doing something in medical education and training that makes doctors act on their unconscious preferences, even though as medical students they may not have done so?” said study leader Adil H. Haider, MD, MPH, an assistant professor of surgery at the Johns Hopkins University School of Medicine. “This may sound like a cliché, but I really do believe that most people who become doctors choose to do so out of a noble calling and they really want to help people. But it may be that training and experience are unwittingly reinforcing negative stereotypes pushing us to unconsciously treat some patients differently. If this is the case, it makes a good argument for interventions to ensure that doctors are aware of how even subtle biases may affect their decision-making and their assessments of patients.”
Previous studies using a validated “association test,” for example, have shown that roughly 70 percent of the general population, as well as doctors specifically, have an implicit preference for white people. One study showed that a group of doctors who were unconsciously partial to white people were less likely to treat black heart patients with needed clot-busting drugs and more likely to give them to similar white patients.
Other past studies have shown that among trauma patients, race and insurance status are independently associated with higher mortality. Minorities are less likely to undergo bypass surgery and are less likely to receive kidney dialysis or transplants, and more likely to undergo less-desirable procedures, such as lower limb amputations for diabetes. Several studies have shown that physicians prescribe fewer analgesics for African-Americans in emergency rooms despite similar estimates of pain.
In the new study, Haider and his team invited first-year Johns Hopkins medical students to participate in a confidential, Web-based survey. They were not informed of the survey content ahead of time and were asked not to share it with their peers afterward.
