Implicit Bias in Medicine Resulting in Patient Care Access Barriers

Racial discrimination and implicit bias in medicine is affecting Black and Hispanic patients at rates three- and two-times more often than White people, and it’s coming to serve as a serious care access barrier, concluded a report from the Urban Institute and the Robert Wood Johnson Foundation.

The report found that 3.2 percent of patients of all races experienced some sort of unfair treatment in the medical setting. That figure came out to 7.7 percent of Black respondents and 5.2 percent of Hispanic respondents, signaling a racial bias permeating the healthcare industry.

And while there are moral issues as it relates to racial discrimination, the report found that implicit bias is having tangible consequences on health outcomes. Nearly three-quarters of those who said they experienced discrimination in the healthcare setting took action to mediate it, with 39 saying they handled it by delaying their medical care.

Postponing patient access to care can have downstream effects, like deteriorating chronic illness or delayed detection of new diseases. Ultimately, that limited care management and preventive care can result in more acute—and often life-threatening—episodes.

What’s more, 30.7 percent of respondents told researchers they didn’t access needed care altogether, and 11.4 percent of patients said the eroded patient-provider relationship led them to dismiss their providers’ advice.

Just over a third of respondents said they looked for a new healthcare provider after experiencing implicit bias in the medical setting, which can come with it some new healthcare delays. It can take time to identify a new provider, obtain an appointment, and become onboarded into the new practice, all of which could impact overall patient health.

None of that is to mention the other downstream effects that can result from taking action against discrimination in the healthcare setting, the researchers continued.

“Beyond the immediate and cumulative emotional toll of these negative experiences, the resulting delayed and forgone care can also lead to poor physical and mental health outcomes,” they wrote in the report.

“Actions like filing a complaint require patients to identify and navigate the appropriate complaint system, and speaking to providers about the treatment received may strain patient-provider relationships that are already shaped by a power imbalance.”

Patients who reported unfair treatment in the medical setting said that poor treatment could come from both clinic staff, like administrative or front desk workers, as well as from clinicians. They said unfair treatment in the medical setting usually manifested itself as rudeness, dismissiveness, discounting of patient symptoms, or misdiagnoses. Patients also perceived unfair treatment when a clinician or staffer treated them as unintelligent or when the worker was uncourteous.

Importantly, the researchers found some respondents were reluctant to describe an encounter as unfair treatment, with the researchers saying those patients seemed to want more concrete evidence that the treatment was malicious. The researchers noted that the treatment aligned with what they considered unfair in the medical setting.

These findings about healthcare were consistent with other social services sectors, the data showed. In addition to investigating unfair treatment in medicine, the researchers found Black and Hispanic people perceived implicit bias when applying to jobs, when interacting with law enforcement, or when trying to rent or buy a place to live.

The results of that unfair treatment go beyond an emotional toll, although that should not be discounted, according to Dulce Gonzalez, a research associate at the Urban Institute.

“Racial and ethnic disparities in treatment and experiences when seeking health care, applying for assistance, or other areas of daily life are rooted in long-standing structural racism, implicit bias, and overt discrimination,” Gonzalez said in a statement emailed to journalists.

“Beyond the immediate and cumulative emotional toll of these negative experiences, perceptions of unfair treatment can result in disruptions and delays to care and needed services, adverse health consequences, and greater hardship in meeting basic needs.”

Healthcare needs to invest in diversity and cultural awareness training as it attempts to dismantle implicit biases. Organization leaders looking to push forward on a mission for health equity will need to identify strategies for employee education, ongoing cultural awareness programming, and a safe and effective mechanism for reporting misdeeds.

“Everyone should be able to live a healthy, productive life free from discriminatory barriers, regardless of race,” Avenel Joseph, vice president for policy at the Robert Wood Johnson Foundation, said in an email. “Leaders at all types of organizations need to embrace and expand education and training about racism and bias, diversify the workforce, and share how all of us can respond to our neighbors in more inclusive ways.”

Healthcare is seeing the consequences of its discrimination issues playing out in public health today. The researchers found many of the Black and Hispanic people surveyed were hesitant about the COVID-19 vaccine, and those who reported previous racial discrimination were more likely to be hesitant than others.

As of publishing time, the fight to get the nation vaccinated is at a critical juncture. As the Delta and Lambda variants course across the country, it will be imperative to get everyone vaccinated. Public and private institutions are now turning from the carrot to the stick with vaccine or mask/testing mandates.

Healing longstanding mistrust and discrimination may not be a feasible solution to an acute problem; that said, identifying populations with reasonable medical mistrust and approaching vaccine hesitancy with empathy will still be a key path toward herd immunity.