There is racial bias in medicine. I do not think anyone genuinely believes otherwise. Everyone I have talked to is in favor of commonsense efforts to rout out racial bias in medical care. I have met many doctors over the years and none of them appeared to be the type to purposely give anyone lower quality care due to race or ethnicity. The key word in my mind is purposely. Doctors are professionals who take their work seriously. Most of the racial bias in medicine is unintentional. I believe the key to reducing racial bias – or any other type of bias in medicine – is awareness. This is especially important in primary care. Of all your physicians (assuming you have more than one) your primary care physician is the one who provides the most information. I once wrote, “at its core, the doctor/patient relationship is an information exchange.” Anything that systematically interferes with that exchange could be an unwelcome bias.
How does racial bias work in primary care? It could be a doctor who does not counsel a black patient to lose weight because he does not think it would do any good. This statement is true of more than just black people. It may be a physician who does not prescribe hypertension drugs or statins for high cholesterol to some patients because she does not believe her Hispanic patients will be compliant. It could be something as simple as ushering a patient in and out of the exam room too quickly because the doctor does not share the same identity with their patient and does not feel a rapport with them. The lack of rapport felt with a patient could create a problem unrelated to race. It could be social status, gender, weight, or other patient characteristics. Bias of any kind is undesirable. In a survey one patient of color mentioned dressing up for doctor visits in an attempt to ensure fair treatment.
I have had doctors spend time in the exam room talking to me about my job as a health economist because they were fascinated by an economist specializing in health care. That little ounce of connectedness could make an enormous difference in my care. One even gave me a discount because he enjoyed talking to me. He was a flight surgeon who charged me the same rate for a flight physical he gives airline pilots even though I was a mere student pilot at the time.
The Wall Street Journal reports medical studies are too white. It is not about inclusion; it is about robust scientific data. For example, during Covid pulse oximeters were used to assess lung function. I have a small device I bought for flying. My wife’s watch has one built into it. It took Covid to reveal what should be obvious: people of color got incorrect readings because of their skin pigmentation.
Yet, one surgeon believes the goal for colorblind medicine can have unintended consequences if done haphazardly. He claims the American College of Surgeons (ACS) has missed the boat in its Diversity, Equity and Inclusion (DEI) toolkit for providers.
The ACS touted the materials would “provide a blueprint for implementing equitable practices,” in medicine.
He argued that the organization was sacrificing quality medical training and patient care by focusing on concepts like “microaggressions,” “implicit bias” and “White privilege” that he says “have no place in medicine.”
I always assumed that surgery is an area of medicine where racial bias is less common, since I cannot imagine a surgeon knowingly reducing the quality of his or her surgical work due to race or ethnicity. I mean, would an anesthesiologist use less anesthesia on one ethnicity compared to another? The surgeon said:
The tool kit is an exhaustive, some might say exhausting, compilation of everything related to pushing the narrative of systemic and structural racism as the source of disparities including minority representation within the ACS and clinical outcomes in minority surgical patients.
The surgeon’s primary complaint is that the ACS wants to divert precious time dedicated to surgical training experience to focus on discussions of diversity, equity, and inclusion. He believes surgical training is the primary goal and should be the top priority, saying:
I have spoken to many of my surgical peers, and we agree that we are already seeing an erosion of quality in surgery, with many programs turning out surgeons who are not ready to practice independently. I have spoken to surgical residents who report a sense that they are not getting the necessary hands-on clinical and surgical experience to feel confident, while being simultaneously tasked with assimilating and regurgitating anti-racist and DEI ideology.
He makes a good point. In the interest of boosting awareness of potential bias in health care we need not sacrifice the most vital component of medical training: that is medical training.