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.