Disparities in Care: Physicians and Racial Bias (2002)

Racism and medicine, it's well known that African Americans are disproportionately affected by illnesses such as heart disease, diabetes and high blood pressure. Although new data indicate African Americans tend to receive poorer care for these and other diseases, then Whites. Poverty and lack of access are only part of the answer, as health correspondent George Straighten(?) discovered, too often it's a matter of race. [music] Late night in New Orleans, Otis Jenkins is just warming up. [music] He's a blue singer, for 37 years his art has imitated his life. [music]

You got to live it, if I've been there, everything I got, I got it the whole all the way. [music] Nothing has come easy, especially good health. Otis has been battling diabetes for 12 years. Two years ago he noticed his big toe was turning purple. They told me the gang green needed to be amputated, so I told him no, I can't do that, it's like, you know, I never had nothing missing on me. Government surveys show Blacks with circulatory problems are twice as likely as Whites to have a leg amputated. Harvard researchers say a major reason is Blacks are less likely to be offered an operation to save the limb. [music] Otis says his doctor never told him he had any other option. I know that on a whole, Black people don't get treated the same as White people in

hospital systems throughout the United States, I know this. If he had a little bit more information, a little bit more support he may have saved his leg if he was offered some alternative treatment. Phyllis Landry works in public health in New Orleans. For some reason, I don't know why African American life is devalued at some point. And it doesn't matter what the illness is, three dozen surveys over the last decade show the disparity in care is pervasive. Black babies are two and a half times more likely to die before their first birthday as White babies. Blacks are 34% more likely to die from cancer and twice as likely to die from heart disease. Blacks are 50% less likely to get heart bypass surgery and the problem is not just with high tech care. Blacks are 25% less likely to get pain medication. Some of the disparities in care can be explained by the fact that as a group, Blacks tend to be poorer, sicker, and have less health insurance.

But 10 different studies done around the country which controlled for these factors show the disparity still exists. [Deep breath, in and out] So what role if any doctor's play? This experiment done two years ago has some answers. Dr. Kevin Schulman designed a simple but elegant way of answering the question no one had ever asked. To what extent are physicians responsible for the differences in care that have caused so much suffering among African Americans? We thought the only way to ever address this question was to have physicians see identical patients. So that they'd have the same clinical characteristics, they'd have the same type of chest pain, they be the same age, they'd be dressed the same way. And then see whether or not given all that, given everything else being equal, whether or not people were treated differently based on their race or gender. We tried to make this as realistic as possible. Dr. Schulman created video discs using actors. White.

'It starts about here, right in the middle and it kind of moves toward my left arm.' Black. 'It starts in the middle here and then it kinda moves into the left arm.' Each reading identical scripts describing heart pain. We tried to make the gestures the same and the gestures went along with the type of chest pain they presented in the cases. Dr. Schulman took the discs and computers to various medical meetings. More than 700 doctors took part in what was described as a government study on clinical decision making. This is the key question. At the end of the examination, the doctors were asked which patient actors needed further advanced treatment. In our main analysis, we found that Blacks were 40% less likely to be referred to cardiac catheterization compared to Whites. Cardiac catheterization is our major diagnostic test to see whether or not people have heart disease, see whether or not they need further treatment or operations or procedures. In our study, the clinical characteristics were identical and yet physicians treated patients differently.

So why the difference? Researchers say it's bias. We think it's subconscious. We think it's not something that physicians are actively doing. It's just an effect of how they automatically characterize people who come in to their office or to their emergency room. The experiment was so well controlled, most say doctors can no longer ignore the subconscious bias many harbor. Researchers do not conclude that doctors are racist, just human. This fall, this website became part of a million-dollar systematic outreach campaign to cardiologists on this issue. Cardiologists were chosen because the disparity data is strongest in heart disease. This and an ad campaign in leading medical journals will show doctors the evidence on disparities and care. This effort is sponsored by two leading health care foundations and 10 medical and public health organizations. We are not saying in this initiative and I certainly am not saying that physicians are the problem, we are saying that physicians can play a leadership role in addressing this issue.