Feb 8
Discrepancies in Quality of Care Towards People of Color
By Alejandro Quezada and Ishita Kaloti
In the United States, there has been a constant uphill battle for minorities to receive equal treatment in all aspects of their life, a battle which has manifested itself in a constant fight against biases, stereotyping, and inequality in numerous sectors of our societies. One of these areas is our healthcare system, an unfortunate notion, considering how far the field has progressed and how much more inclusive it has become over the past few decades. While progress has been made, there remain numerous discrepancies in the ways that physicians interact with patients who are people of color (POC), the quality and amount of care that POC patients receive, and the understanding of symptoms and diseases that may be unique or more prevalent in these ethnicities.
There are a multitude of factors that lead to discrepancies in the quality of care of people of color, with one of the most prevalent being implicit bias. Implicit bias is unconsciously associating attitudes or beliefs toward social groups that can lead to the manifestation of discriminatory behavior. Due to the existence of implicit biases, individuals often attribute certain characteristics to all members of a particular group. Usually, these attitudes are present but are not consciously recognized by individuals holding them.
A study published by Hall et al. in the American Journal of Public Health states that “Most health care providers appear to have an implicit bias in terms of positive attitudes toward Whites and negative attitudes toward people of color.” Due to the presence of bias in our healthcare providers, POC patients are known to be treated differently when compared to their white counterparts. Countless studies report a similar pattern of findings where Black and Hispanic patients especially are treated differently. Due to the presence of the stereotypes that are associated with minority populations, POCs sometimes are not offered adequate health recommendations like medication options, medical procedures, referral to specialists, etc. which leads to the point of low quality of care.
The existence of racial disparities in doctor’s offices is an issue that is widely known and is being studied extensively today. It is also essential to highlight that the discrepancy also exists for children of color. Children of color are not protected from the harsh reality of the prejudiced world we live in. Unfortunately, they also experience a poorer quality of care from their healthcare providers when compared with white children. The unconscious attitudes held by physicians about race have an effect on pain management. A study by Sabin and Greenwald published in the American Journal of Public Health reported that “as pediatricians’ implicit pro-White bias increased, prescribing narcotic medication decreased for African American patients but not for the White patients.”
The discrepancy lies not only in the prescription of pain medication but other types of medications as well. Since there are stereotypes associated with minorities in relation to the misuse of medications and drugs, children are often prescribed either generic medications, medications in lower doses, or none at all. These decisions negatively impact children and can have a profound effect on their overall health as well. In simple terms, this is unfair treatment, as it is ethically wrong to prescribe medication based on one’s preconceived notions about minorities and drugs. Additionally, stereotyping and bias can lead to a misdiagnosis of child abuse as much as nine times as often in black children who present with injuries compared to white children, as found in a 2002 study by Lane et al. This is alarming as the implications of this could lead to repercussions for their caregivers and unnecessary treatment. Since these biases are unconscious, it is important for physicians to learn how to recognize their own shortcomings for the benefit of their patients.
Additionally, the dominance of white physicians in healthcare still exists and can negatively impact patients due to the inability to connect with them on a more personal level and bias. According to the Association of American Medical Colleges (AAMC), 56.2% of American physicians are Caucasian, making up a significant portion of our healthcare system. It should be noted that medical schools and residency problems have begun to put an emphasis on teaching upcoming physicians about diversity and differences in symptoms and experiences across POC; however, a large amount of the time people’s own implicit biases can hinder this progress. As a result of this, the health of minority patients can be compromised and these discrepancies arise.
While many of these statistics and trends are disappointing and reflect the worst of our healthcare system, it should be noticed that there are steps being taken in the right direction to promote diversity and encourage healthier interactions between physicians and POC. One stride is how medical school applicants in the United States are required to complete exams that evaluate their ethics and situational judgment, such as the CASPer test, which can provide medical schools with an idea of how the people looking to enter the medical field respond to situations involving a variety of patients including POC. Additional solutions that could potentially address these discrepancies include having more of an emphasis on diversity and physician ethics when aspiring physicians get their board certifications, introducing diversity awareness training in hospitals to educate healthcare professionals on these issues and get them to realize their own implicit biases they intentionally or unintentionally carry, and educating POC patients on how they can look out for these discrepancies and where to report them.
Sources:
Bernstein, Kimberly M., et al. “Racial stereotyping and misdiagnosis of child abuse.” American Psychological Association Judicial Notebook, vol. 51, no. 5, 2020, pp. 35. https://www.apa.org/monitor/2020/07/jn
Bridges, Khiara M. “Implicit Bias and Racial Disparities in Health Care.” American Bar Association Human Rights Magazine, vol. 43, no. 3. https://www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/racial-disparities-in-health-care/
“Diversity in Medicine: Facts and Figures 2019.” AAMC, https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018.
Hall, William J et al. “Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review.” American journal of public health vol. 105,12 (2015): e60–76. doi:10.2105/AJPH.2015.302903
Lane, W., et al. “Child Abuse and Neglect.” Scandinavian Journal of Surgery, vol. 100, no. 4, 2011, pp. 264–272., https://doi.org/10.1177/145749691110000406.
Morden, Nancy E., et al. “Racial Inequality in Prescription Opioid Receipt — Role of Individual Health Systems.” New England Journal of Medicine, vol. 385, no. 4, 2021, pp. 342–351., https://doi.org/10.1056/nejmsa2034159.
Sabin, Janice A, and Anthony G Greenwald. “The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma.” American journal of public health vol. 102,5 (2012): 988–95. doi:10.2105/AJPH.2011.300621.
Zhang, Xingyu, et al. “Racial and Ethnic Disparities in Emergency Department Care and Health Outcomes Among Children in the United States.” Frontiers in Pediatrics, vol. 7, 2019, https://doi.org/10.3389/fped.2019.00525.
Alejandro Quezada is a fourth year Physiological Science major at UCLA.
Ishita Kaloti graduated from UCLA in 2021 with a B.A. in Psychology. Alejandro and Ishita are both THINQ 2021–2022 clinical fellows.
Visit our website at thinq.med.ucla.edu and follow us on Facebook and Instagram @uclathinq!
