Sunday, June 7, 2015

Are Physicians Racist?

Racism and prejudice are endemic in America.  Many of us reflexively answer, No, if we are asked if we are prejudiced.  I don’t.  I say yes.

While I do my best to give everyone a fair shake, I grew up in a white suburban family in the latter decades of the last century.   My friends, my parent’s friends and all those we associated with were all the same color.  In elementary school, there was but a single black girl in our classroom.

Is it possible for a white kid to grow up surrounded by all of the overt and covert prejudicial and stereotypical influences and somehow emerge pure?   I don’t think so.   Prejudice today among those of us who consider ourselves to be enlightened is more subtle and often hard to recognize.

I don’t want to overplay this here.  I often feel that a charge of prejudice with regard to race, gender, age or religion is spurious and is launched to advance a personal or a political agenda.  We all know this to be true and these instances deserve condemnation.   Sometimes, an applicant doesn’t get the job simply because he or she doesn’t deserve it.

The medical profession, as an integral segment of our society, is not immune to this phenomenon.  I’ve been reading over several years that medical professionals provide different levels of service to different races.   The Institute of Medicine convulsed the profession with its 2002 report that reported that blacks and minorities received fewer heart bypass operations, kidney dialysis treatments, proper cardiac medications and cancer detection tests than did whites, even after controlling for insurance status and other variables. 
More recently, in 2012, a University of Illinois psychology professor wrote that physicians prescribed more pain medicine to whites than to minorities for the same broken leg.  Seems hard to believe.

You Shall Have Just Balances, Just Weights
Leviticus 19:36

As a physician, I find these reports to be preposterous, yet I cannot comfortably deny them either.  I can’t fathom, for example, that I would prescribe less morphine to a Hispanic man suffering a heart attack than I would to a white patient.  In fact, no doctor I know or work with would admit to this behavior.   Leaving overt racists aside, no physician believes that he provides unequal care to his patients.   In fact, most would zealously and sincerely refute such a charge.

The point by those who differ with defensive doctors like me is that the prejudicial treatment is unconscious and, therefore, cannot be detected by the physician perpetrators. 

I am not accepting all of this as irrefutable truth, but I believe that the disparate medical care provided to different segments of our population needs to be explained.  It’s a complex issue and there are many moving parts at play here.  It is certainly possible that physician bias is an explanatory factor.

I remind my physician colleagues that for years we vigorously denied that pharmaceutical salesmen who came to our offices with food and drink influenced our prescribing habits.  We now know the truth here and we should admit that we are susceptible to influences that we cannot easily detect.

I do my very best to treat every patient equally.  If I am not doing so, I am truly not aware of it.     Like many medical conditions, the challenge is in the treatment, not the diagnosis.    

Hidden biases are not restricted to healers.   Law enforcers, educators, juries, salesmen, hiring managers, journalists and the rest of us are not as pure as we think we are.  Contemplating our prejudices is sensitive, nuanced and personal - not a simple black or white issue.

As published in the Cleveland Plain Dealer.


Augustine L. Perrotta, DO said...

Please have your white guilt treated appropriately. Physicians are the least racist and prejudicial of any occupation on the face of the earth.

Venkat Pericherla said...

Racism is still alive. CEOs and some ignorant physicians do not consider other non white physicians as equals. But when treating patients there is very little racism possibly due to fear of law suits.

Michael Kirsch, M.D. said...

Augustine, thanks so much for commenting. I also do not perceive any racism in my professional dealings. My point is that we may be suffering from unconscious bias, a phenomenon that has been well documented. In addition, how do you explain the racial discrepancies in medical care that have been documented, only a portion of which I cited in my essay? Will you opine that the studies are flawed? If you read my piece carefully, you will see that I was rather nuanced about the issue, trying to use words carefully. I think the 'white guilt' accusation is rather ad hominem. Appreciate your view.

suziq38 said...

Having grown up in Southern California in the 60's, I know first hand what racism feels like.
People who look you up and down because you were not the same color, no matter what the majority color is.
Difficulty finding friends or getting a decent job other than a fast food worker or motel maid.
Try getting a date to the prom in high school, or a friend's parent asking you if you ate fish heads for dinner every night.

Thankfully, things have changed.
That being said, there are always jerks out there, like a teacher from Texas who actually said on social media that the blacks were the ones causing all of the problems at school and in town....imagine.

I will have to say that no doctor ever mistreated me or other members of my family because of race.

CL Cupid said...

It interesting that many healthcare professionals aren't trained specifically in the art of delivering medicine in a culturally competent way. Empathetic communication skills are woefully deficient in the healthcare field. It may be argued that racism, classism or any other "ism" is present or absent in the medical field, but what is undeniable is the emotional incompetence that exists among the healthcare population in general.

If a black patient accuses his white doctor of being a racist, it is never really about race it is about the lack of emotional connection between provider and patient. I teach healthcare professionals how to use empathy and rapport building techniques to connect with patients on a level deeper than race--the level of humanity.

When physicians and nurses learn to, not deny that racism exists in healthcare, but to realize that it really becomes a moot point in the face of empathetic connection.

Learn more at

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