Pediatricians' pain-medication judgments affected by unconscious racial bias, study says

Pediatricians who show an unconscious preference for European Americans tend to prescribe better pain-management for white patients than they do for African-American patients, new University of Washington research shows.

Pediatricians responded to case scenarios involving medical treatments for white and for four common pediatric conditions.

"We're talking about subtle, unconscious attitudes that are pervasive in society. Because these are unconscious attitudes, doctors aren't aware that their may affect their ," said Janice Sabin, a UW research assistant professor in the Department of and Medical Education, a part of UW's School of Medicine.

She is lead author of the study published March 15 in the .

Sabin's previous research showed that pediatricians display less unconscious race bias than other or the general population. Still, unconscious beliefs can affect how doctors interact with patients, and the current study reveals that those attitudes can influence doctors' treatment decisions.

"Coupled with known racial and in health care, our findings suggest that well-meaning physicians may unconsciously treat people differently in some areas of care," said Sabin.

Among the 86 pediatricians who participated in the study, 65 percent were female, 82 percent were white and 59 percent were medical residents or fellows. They completed three Implicit Association Tests to measure unconscious attitudes and beliefs.

The test was developed in 1998 by Anthony Greenwald, a co-author and a UW . The test measures by asking participants to quickly classify several series of words or visual images as they appear on a computer screen. The patterns of speeds in response to varied classification instructions can reveal automatically operating biases.

Sabin chose four conditions commonly treated by pediatricians – asthma, attention deficit hyperactivity disorder, urinary tract infections and pain. Case scenarios were created for each condition for both an African-American and a white patient.

For the asthma, ADHD and urinary tract infection case scenarios, doctors did not show an association between unconscious attitudes about race and treatment decisions for the two patients. However, recommendations for optimal pain treatment decreased for the African American patient as doctors' pro-white bias increased.

"Implicit biases are surprisingly pervasive, and in certain circumstances they can affect how people behave," Sabin said. She said her findings "indicate that more research should be done to see if unconscious biases affect real-world medical care and treatment decisions, especially for pain management."

"This is exactly the type of result that was anticipated by the Institute of Medicine's landmark 2002 Unequal Treatment study," Greenwald said. "That study and other studies found, among other indications of troubling health care disparities, underuse of pain medication for African American patients."

Because physicians are likely unaware of unconscious attitudes and beliefs and the unintended disparities that may result, incorporating awareness of personal bias and methods to avoid the influence of bias on decision-making into medical education, continuing medical education and training of health professionals is necessary for health sciences education, Sabin suggested.

Related Stories

Emergency treatment may be only skin deep

Aug 20, 2007

Doctors’ unconscious racial biases may influence their decisions to treat patients and explain racial and ethnic disparities in the use of certain medical procedures, according to Alexander Green from Harvard Medical School ...

Recommended for you

Suddenly health insurance is not for sale

Apr 18, 2014

(HealthDay)— Darlene Tucker, an independent insurance broker in Scotts Hill, Tenn., says health insurers in her area aren't selling policies year-round anymore.

Study: Half of jailed NYC youths have brain injury (Update)

Apr 18, 2014

About half of all 16- to 18-year-olds coming into New York City's jails say they had a traumatic brain injury before being incarcerated, most caused by assaults, according to a new study that's the latest in a growing body ...

Autonomy and relationships among 'good life' goals

Apr 18, 2014

Young adults with Down syndrome have a strong desire to be self-sufficient by living independently and having a job, according to a study into the meaning of wellbeing among young people affected by the disorder.

User comments