Conversations about institutional racism in the United States have recently focused on police brutality and socioeconomic disparities that keep families mired in intergenerational poverty. But the issues go beyond that, affecting other sectors of society that many Americans may not associate with racial justice.
For instance, implicit bias — attitudes that lead doctors or researchers to unconsciously treat people of color differently — permeates the health care system.
“The problem lies in when we use such bias to make decisions in the workplace that advance the progress of some while hindering others. It happens when we have stereotypical assumptions about some groups,” Laura Castillo-Page, Ph.D., the senior director for diversity policy and programs at the American Association of American Colleges (AAMC), told ThinkProgress. “That makes us overlook their skills. It happens in faculty and student recruitment often.”
This stark reality compelled members of Castillo-Page’s organization to partner with a leading consulting company to design a training program for medical professionals and faculty members at medical schools. The module, named the Every Day Bias Workshop, aims to teach doctors, researchers, and professors how their assumptions affect the decisions they make about communication, innovation, employment, and organizational culture.
“This program helps people understand how to mitigate bias so they can make more equitable decisions,” Castillo-Page said. “We wanted to develop something that could be used in medical schools and teaching hospitals. Going through this training allows us to see how bias is in each of us.”
Going through this training allows us to see how bias is in each of us.
For the second consecutive year, AAMC hosted sessions around the country that attracted human resources managers, executives, educators, and counselors. During a workshop at Stanford School of Medicine scheduled for October, participants will mull over how to practice self-realization. The goal is to help medical professionals become more aware of their bias so they can learn to stop themselves in situations when bias may adversely affect their decision-making.
The Kirwan Institute for the Study of Race and Ethnicity, based at Ohio State University, says that implicit bias — also known as “implicit social cognition” — affects people of all walks of life, even Americans who hold positions that require impartiality. It often thrives on the influence of early life experiences, media and news programming, and associations derived from stereotypes. Buried deep within the subconscious, bias leads people to favor their own background over others, affecting their perspectives about different racial, ethnic, and age groups.
This is a big problem in medical education and health care. A growing body of research suggests that stereotypes held by doctors often affect clinical decisions related to patients of certain racial backgrounds. A study conducted by the Institute of Medicine found that black Americans received less effective care than their white counterparts, socioeconomic and insurance status notwithstanding. Patients of color also received fewer recommended treatments for chronic illness, including HIV/AIDS, cancer, and heart disease. Differences in practitioner-patient interaction played a part in widening disparities.
Lekeisha Sumner, an associate professor at Alliant International University in Los Angeles, California, says these disparities in patient care are remnants of America’s turbulent racial history that continues to haunt communities of color. “During slavery, it was widely believed that African Americans didn’t need medication because they had a high tolerance for pain. It’s a striking parallel that today blacks tend to receive poorer quality care and are under-treated for pain, although today this occurs largely outside of conscious awareness,” Sumner told ThinkProgress. “Implicit bias among health professionals — who want the best outcomes for their patients — may lead to subtle attitudes and behaviors that undermine optimal treatment outcomes through their clinical decision-making and relationships with patients.”
Implicit bias also affects the health care system on a more institutional level. Some patients of color may not be able to afford the appropriate treatment because of hospital administrators’ decisions to reject insurance plans that commonly serve disadvantaged members of ethnic groups. In their plans to open new physicians’ offices, medical institutions may also overlook certain neighborhoods with high concentrations of non-white residents.
Patients may not be as forthcoming in describing everything that’s happening to them.
Prospective students of color and faculty members also feel implicit bias’ impact. Medical school admission among black students has declined in a 20-year period, according to a study published in the New England Journal of Medicine. In 2012, black men accounted for less than 600 medical school graduates, with the highest concentration coming from historically black institutions Howard School of Medicine, Meharry Medical College, and Morehouse School of Medicine.
Enrolling and educating more medical students of color could prove beneficial to patients.
Though African Americans and Latinos account for one in eight and one in six of the U.S. population, respectively, fewer than 20 percent of doctors identify as members of either ethnic group. Doctors of color can bring new perspectives that preclude them from acting against their patients’ best interests, due in part to an ability to resonate with their fears of being mistreated by those in power. Experts say doctors of color lead more patient-centered conversations, encourage more questions, and offer cultural understanding that leads to better health outcomes.
Educating a multiethnic coalition of doctors may be easier said than done. Students of color at predominately white institutions may not fare as well in an environment that doesn’t accommodate their unique academic and personal needs.
During an interview with ThinkProgress, Walker Keenan, an African-American medical student at University of California, San Francisco, recounted the racial microaggressions he has experienced on campus. “I’ve been asked my country of origin in some cases. When I tell people I go to UCSF, they tell me that I got in because of my race,” Walker Keenan, 23, a member of #WhiteCoats4BlackLives, a medical student-run organization that aims to eliminate racial bias in medicine, told ThinkProgress.
Last year, #WhiteCoats4BlackLives members held die-in demonstrations at medical schools across the country after the non-indictments of police officers who killed Michael Brown in Ferguson, Missouri and Eric Garner in New York City. Keenan said some schools, including his own, have since made strides in creating a more inclusive environment for students and faculty of color, though there’s more work left to be done.
When I tell people I go to UCSF, they tell me that I got in because of my race.
“There are some schools with an underrepresented minority patient population that are unable to provide a medical education to qualified students of color. Physicians of color are also more likely to see patients of color who are in need but no one is speaking for those populations. That’s why we have to increase financial aid and residency positions for students of color,” Keenan, now in his second year of medical school, said. “For us, there’s often a drop off in diversity between medical school and admission of people of color into residency programs.”
But some improvements in the health care space for people of color may be on the horizon.
The Every Day Bias Workshop counts among several recent attempts to confront implicit bias in medical settings. Pharmacy students at UCSF, for example, took an implicit association test this year, answering a series of questions on a computer about their attitudes toward race, gender, age, weight, and other categories. A recent study out of the University of Washington implicated health care providers in their prejudice toward members of the LGBT community, prompting conversations about how to best make medical facilities more inclusive.
Laura Castillo-Page, too, said AAMC has seen some success in its endeavor to level the proverbial playing field.
“People have been really receptive. Now that some participants have been certified, they’ve taken their training back to their institutions,” she said. “If we can change people’s understanding of bias and ultimately their behaviors, admissions committees will be more open to students of different backgrounds. The same thing applies in faculty recruitment and advancement and in the delivery of patient care. Through unconscious bias training, opportunities are opened for everyone, whether it be applying to medical school or in the delivery of health care.”