How coffee shop racism harms black patients

May 8, 2018 by Junaid Nabi, Public Library of Science
How coffee shop racism harms black patients

A couple of weeks ago, two black men entered the Philadelphia Starbucks store to meet a friend, and have a conversation, just like many of us usually do. Unlike many of us, however, they were arrested for trespassing – after minutes of taking their seats. A phone call – that lasted only 30 seconds – led to an arrest of these young individuals, and a national conversation on race relations in the United States in the ensuing days.

This reprehensible incident is an important reminder of how implicit – or in this case coffee shop racism – works. While this incident has been condemned widely, the service industry is not the only sector where this is a problem. Implicit racial biases are in fact important indicators of the broader negative perception of black people – which in often leads to low-quality care, and harm.

How does this racial bias translate to harm in clinical practice?

In 2016, psychology scientists from University of Virginia demonstrated how racial bias lead to disparities in pain management. The investigators reported that black patients are systematically undertreated for pain compared to white patients.

They found that a significant number of white medical students and residents believed in false biological differences between white and black patients, such as "black people's skin is thicker" and that "black people's blood coagulates more quickly." These findings exemplified how racial bias leads to less accurate treatment recommendations for black patients.

In another milestone report, the American Journal of Public Health revealed how implicit racial bias – even if unconscious – leads to reduced trust in the doctor-patient relationship, causes black patients to feel less respected by their doctors, and may contribute to in healthcare.

Some of this implicit bias has a historical precedent. In a series of revealing articles last December, the Boston Globe's Spotlight team illustrated how black patients were continuously discriminated against in the 1960s and 1970s. In fact, the report documented that such discrimination continues today – although it has taken new forms: today, it is more systematic and less individualistic.

What can academic medicine learn from such incidents?

As a physician-bioethicist, I am training to develop research protocols that are equitable and apply regardless of race of an individual. But after witnessing incidents where are routinely harassed, I believe it is a moral imperative to consider broader societal impositions on black individuals for any bioethical analysis – a feature that academic training programs have not addressed adequately.

It is a mistake to think that black patients' exacting social environments do not affect their agency. Understanding – and addressing – how unfair social forces shape the health of black patients must start early in the medical training. One way to address this issue is to teach medical students to take a more thorough social history, that includes documenting instances of racial bias.

In 2014, a report from the Robert Wood Johnson Foundation emphasized: "Your health care depends on who you are. Race and ethnicity continue to influence a patient's chance of receiving many specific health care procedures and treatments."

To be sure, most are not actively discriminating against minority patients, but just like the Starbucks manager who called the cops on two innocent , the tendency to discriminate is often implicit. Unless one is intentional about their approach to patient care in minorities, it is far too easy to fall in the trap of casual racism.

Black communities already suffer from worse clinical outcomes. Black patients continue to have inadequate access to healthcare; black women are two to three times more likely to die from pregnancy- and childbirth-related complications than white women; and, mortality rate in black infants has not improved in recent years.

Many of these outcomes are driven by implicit bias, which continues to put undue stress on black patients. Implicit racial biases contribute to this perception.

It is important for academic medicine to recognize this issue. A conversation on how culture affects medical care is long overdue. Healthcare providers – and by extension students who are learning from them – are operating on a flawed understanding that societal racism (casual in many instances) does not affect medical care. As noted above, evidence suggests otherwise.

Healthcare providers are in a unique position to address racial bias. By making small intentional changes in routine clinical practice, such as focused empathy and a thorough social history, it is possible to elevate the quality of care for and other minorities that routinely confront racial . These small initiatives may help alleviate some of the health disparities.

Equitable medical care can be great equalizer of the health conditions of minority .

Explore further: Doctors' biases mean black men don't get the same treatment in healthcare

Related Stories

Doctors' biases mean black men don't get the same treatment in healthcare

February 21, 2017
A new qualitative study has shown that previous bias and fear of black men likely result in them not getting the same healthcare as white male patients.

Reducing racial bias possible in older children, study finds

July 13, 2016
Research has shown children have racial biases from an early age, but a new University of British Columbia study has found that it is possible to combat prejudice in older kids.

Dialysis providers' awareness of racial disparities in transplantation is low

April 12, 2018
In a recent study of dialysis facilities with low rates of waitlisting for transplantation, healthcare providers' awareness of racial disparities in kidney transplant waitlisting was low. The findings, which appear in an ...

Racial disparities in HIV control persist despite equal access to care

March 21, 2018
Researchers report that racial disparities in HIV control (viral load) exist even when patients have equal access to care, as shown in a study of black and white HIV-infected patients treated in the Veterans Administration ...

Physician implicit racial bias does not impact their clinical decision making

August 7, 2017
A doctor's racial preference does not necessarily mean he or she will order more or fewer diagnostic tests or treatments based on race. That is the primary indication of a study to be published in the August 2017 issue of ...

Recommended for you

Father's nicotine use can cause cognitive problems in children and grandchildren

October 16, 2018
A father's exposure to nicotine may cause cognitive deficits in his children and even grandchildren, according to a study in mice publishing on October 16 in the open-access journal PLOS Biology by Pradeep Bhide of Florida ...

Study finds evidence of intergenerational transmission of trauma among ex-POWs from the Civil War

October 16, 2018
A trio of researchers affiliated with the National Bureau of Economic Research has found evidence that suggests men who were traumatized while POWs during the U.S. Civil War transmitted that trauma to their offspring—many ...

Many supplements contain unapproved, dangerous ingredients: study

October 13, 2018
(HealthDay)—U.S. health officials have issued more than 700 warnings during the last decade about the sale of dietary supplements that contain unapproved and potentially dangerous drug ingredients, new research reveals.

Age at which women experience their first period is linked to their sons' age at puberty

October 12, 2018
The age at which young women experience their first menstrual bleeding is linked to the age at which their sons start puberty, according to the largest study to investigate this association in both sons and daughters.

The long-term effects of maternal high-fat diets

October 12, 2018
If a mother eats a high-fat diet, this can have a negative effect on the health of her offspring—right down to her great-grandchildren. This is the conclusion drawn by researchers at ETH Zurich from a study with mice.

First ever meta-analysis on Indian lead exposure reveals link to devastating intellectual disability in children

October 12, 2018
New Macquarie University research has revealed the devastating disease burden associated with elevated blood lead levels in India. The results of the first ever meta-analysis of Indian blood lead levels found the burden of ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.