Does the Color of Your Skin Affect Your Medical Treatment?

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November 26, 2012 ‐ By Terri Williams

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Mitt Romney’s disparaging pre-election comments about the “47 percent,” and his post-election accusations that President Obama “bought” the election by promising gifts to key voting groups, added fuel to the firestorm sparked by Obamacare, which many people view as favorable to low-income Americans, many of whom are black.

Romney’s comments come on the heels of an October 2012 Stanford University and AP survey, in which respondents were asked how well certain terms, such as “lazy,” “hardworking,” “violent,” and “friendly” described blacks, Hispanics, and whites. The results reveal that 51 percent of Americans have an anti-black attitude, up from 48 percent in 2008. The question is whether these assumptions determine how black people are treated across many facets of life, including the most important, medical care. An individual’s health is one of their most precious resources – it determines if they can hold a job, purchase a house, have children, even reach for the American dream. But is it possible that skin color can even affect the level of medical treatment that a black person receives?

Racial bias in medical care can and does affect the level and quality of patient care delivered, as well as the quality of the physician-patient relationship.  And in a 2012 study published in the American Journal of Public Health, researchers discovered that although doctors were not overtly racist, their unconscious biases and preferences towards white patients were revealed using the Implicit Association Test (IAT). The study, which involved 40 primary care physicians and 269 patients in the Baltimore area, measured reaction times to good and bad words associated with pictures from each race.  The IAT is a popular tool for measuring subconscious views because the test questions and responses are so rapid that participants don’t have time to think about their responses.

The results revealed that the physicians viewed black patients as being less cooperative with medical procedures and less cooperative in general. In addition, the more negatively a physician viewed the patient, the less likely the chances that the patient would be offered treatment.

The study also utilized recorded medical visits between physicians and their patients (which were authorized by both parties). The audio recordings revealed that when speaking with black patients, physicians were more likely to speak at a slower rate and they also dominated the conversation. In addition, the doctors had a less positive emotional tone.

This study is consistent with a 2011 study of over 200 first-year medical students at Johns Hopkins School of Medicine that was published in the Journal of the American Medical Association.  That study revealed that the majority of respondents had an implicit preference for white patients.

Whether implied or explicit, medical biases are detrimental to black patients. For example, in 2008, researchers at UCSF evaluated data from a National Hospital Ambulatory Medical Care Survey, which studied the treatment of pain in U.S. emergency rooms. The data identified reasons for the emergency room visit and the physician diagnosis codes. The results, which were published in the Journal of the American Medical Association, found that emergency room physicians were more likely to give opiods – such as vicotin or oxycotin – to white patients who complained of pain than to black patients with the same complaints.

Also, a 2009 study at Georgetown University, which was published in the American Journal of Transplantation, revealed that black and Hispanic patients were less likely to receive kidney/pancreas transplants than white patients.

These types of incidents reduce the trust level of black patients towards the medical profession.  Blacks are severely under-represented in medical research and a study conducted by the Children’s Hospital of Pittsburg and the University of Pittsburg Graduate School of Public Health reveals that mistrust is the primary reason for a lack of research participation.

The 2009 study published in the Archives of Pediatrics and Adolescent Medicine examined racial differences in the willingness of parents to enroll their children in research programs.  White parents were twice as likely as black parents to allow their children to participate in clinical research. One of the study’s lead researchers, Dr. Kumaravel Rajakumar, in an article in Medical News Today, noted that the participation of blacks is vital for determining the extent to which research findings can be applied to the African-American race.

However, the study’s results revealed that 67 percent of black parents did not trust medical research; 40 percent believed that doctors prescribe medications so they can experiment on participants without their consent; and 46 percent did not think doctors would be truthful if the research involved too many risks.

The cumulative effect of racial bias and discrimination in medical care is a guarded — perhaps even antagonistic — physician-patient relationship. Racial biases that hinder the level and quality of care that black patients receive. This in turn, creates doubt in the benevolence of primary care providers, and black patients may be more likely to reject medical advice or even forego medical treatment.  It’s a prescription for disaster.

The limited available research appears to support this theory. A 2006 study used focus groups in Chicago to determine how blacks view the trustworthiness of physicians. In the study, published in the Journal of General Internal Medicine, researchers concluded, “Distrust inhibits care-seeking, can result in a change in physician and may lead to nonadherence.”

Slate reported in 2009 on some research that showed that simply making doctors report back on the medical exams and treatment they administered equalized the results between black and white patients. “Over and over, this theme recurs: Universal quality-improvement plans coupled with publicly reported measures are the best way to cut health disparities,” the article says. Based on the empirical evidence we’ve supplied here, we would disagree with the article’s statement that the issues and prejudices associated with race become negligible when this sort of accounting is put in place. Just to be on the safe side, we would suggest that you keep the lines of open, honest, and respectful communication with your doctor. And if it becomes too difficult to establish and maintain a relationship with your doctor, find a new one fast.

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