Unconscious Bias Against Blacks Can Contribute to Inferior Care, Study Finds
Unconscious bias might explain why blacks are less likely than whites to receive potentially lifesaving treatment, such as clot-busting drugs for heart attacks, according to a new study published on the Web site of the Journal of General Internal Medicine, the Boston Globe reports.
For the study, lead author Alexander Green of Massachusetts General Hospital, and colleagues asked 220 people training in Boston and Atlanta to become emergency department physicians to diagnose a hypothetical case in which a 50-year-old man arrived at the ED experiencing sharp pain. Participants viewed a computer-generated image of the patient, either a black or white male, shown from the chest up with a neutral facial expression. Researchers asked the participants -- who were white, Asian, Hispanic and black -- whether they believed the man was having a heart attack and if they would administer a clot-busting drug commonly used to stabilize patients having a heart attack.
The physicians also participated in a 20-minute, computer-based test designed to detect overt and implicit prejudice. In the test, white, Asian and Hispanic participants were slow to associate positive concepts, such as cooperativeness, and quick to associate negative concepts with black patients. Black participants were as likely to demonstrate bias against black patients as they were against whites. The concept behind the test is that the strength of participants' perception is related to the speed in which they match certain qualities with pictures of patients.
Researchers compared results of the test with physicians' decisions to administer clot-busting drugs to the hypothetical patient. They found that doctors whose ratings of blacks were the most negative also were less likely to administer the drugs to blacks.
"It's not a matter of you being a racist. It's really a matter of the way your brain processes information is influenced by things you've seen, things you've experienced, the way media has presented things," Green said. He added that he could not determine a reason for the findings.
According to the Globe, other experts suggested that medical personnel take a test to measure unconscious bias. Mahzarin Banaji, a psychologist at Harvard University who helped design the bias test used in the study, said, "The great advantage of being human, of having the privilege of awareness, of being able to recognize the stuff that is hidden, is that we can beat the bias."
Amal Trivedi, a racial health disparities specialist at Brown Medical School, said, "At the end of the day, even among very well-intentioned people, implicit biases can be both prevalent and in some situations, can impact clinical decisions. What this study can do is raise awareness of that finding" (Smith, Boston Globe, 7/20).
An abstract of the study is available online.