Implicit Associations Regarding Race and Medical Care
The Boston Globe has an article today about implicit associations regarding race and their effects on medical care:
Researchers have known for years that African-Americans in the midst of a heart attack are far less likely than white patients to receive potentially life-saving treatments such as clot-busting drugs, a dramatic illustration of America's persistent healthcare disparities. But the reasons behind such stark gaps in care for heart disease, as well as cancer and other serious illnesses, have remained murky, with blame fixed on doctors, hospitals, and insurance plans.
In the new study, trainee doctors in Boston and Atlanta took a 20-minute computer survey designed to detect overt and implicit prejudice. They were also presented with the hypothetical case of a 50-year-old man stricken with sharp chest pain; in some scenarios the man was white, while in others he was black.
"We found that as doctors' unconscious biases against blacks increased, their likelihood of giving [clot-busting] treatment decreased," said the lead author of the study, Dr. Alexander R. Green of Massachusetts General Hospital. "It's not a matter of you being a racist. It's really a matter of the way your brain processes information is influenced by things you've seen, things you've experienced, the way media has presented things."
[ . . . ]
"Years of advanced education and egalitarian intentions are no protection against the effect of implicit attitudes," said Dr. Thomas Inui, president of the Regenstrief Institute Inc. in Indianapolis, which studies vulnerable patient groups. "When do they surface? When we're involved with high-pressure, high-stakes decision-making, when there's a lot riding on our decisions but there isn't a lot of time to make them, that's when the implicit attitudes that are not scientific rise up and grab us."
[ . . . ]
The best way to combat those impulses is by acknowledging them, specialists said, suggesting that medical personnel take a test to measure unconscious bias, such as one at implicit.harvard.edu.
"The great advantage of being human, of having the privilege of awareness, of being able to recognize the stuff that is hidden, is that we can beat the bias," said Mahzarin R. Banaji, a Harvard psychologist who helped design a widely used bias test.
The article goes on to acknowledge that the problem of healthcare disparities is much more complex than that, but I wanted to highlight this because I think it's a good illustration of the problems of unconscious bias and what can be done about it.
I'm putting the methodology sections behind a cut, because the Globe's articles tend to go away very quickly. However, you can read up on implicit association tests and try them yourself: background information on Project Implicit, including a FAQ, and demo tests.
I encourage people not to turn the tests into a meme where you post your results. I found it really hard to take even a test I thought I'd do "well" on, and I'm still gearing myself up to take a test that might come out differently. Self-awareness is the goal, here, and I can't imagine that memifying the tests will help.
Here's what the Globe article said about the study's methodology:
Green and his colleagues decided to test residents at Massachusetts General, the Brigham, and Beth Israel Deaconess Medical Center in Boston, as well as at an Atlanta hospital. Residents were told that the study was evaluating the use of heart attack drugs in the emergency room, but not that it was also examining racial bias; 220 trainee doctors were counted in the results.
The residents were first given a narrative describing a male patient who shows up in the emergency room complaining of chest pains. Accompanying the narrative was a computer-generated image of the patient, either a black or white man shown in a hospital gown from the chest up, wearing a neutral facial expression.
The doctors were asked if, based on the information provided, they would diagnose the man as having a heart attack and, if so, whether they would prescribe clot-busting drugs called thrombolytics, commonly used in community hospitals to stabilize patients having heart attacks, and how likely they were to give those drugs.
Study participants were also asked questions designed to determine if they were overtly biased. Answers showed they were not.
Last, the residents took Banaji's "implicit association test," which is based on the concept that the more strongly test-takers associate a picture of a white or black patient with a particular concept, say cooperativeness, the faster they will make a match. White, Asian, and Hispanic doctors were faster to make matches between blacks and negative concepts and slower to make matches between blacks and positive ones. The small number of African- American physicians in the study were as likely to show bias against blacks as against whites.
The researchers then compared the implicit association test scores with the decisions about whether to provide the clot- busting medicine and found that doctors whose ratings of African-Americans were most negative were also the least likely to prescribe the drug to blacks.
Another study, scheduled to be presented by a Johns Hopkins medical researcher in October, reaches similar results.