Implicit Bias in Stroke Care

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Researchers now say Latinos and blacks experiencing a stroke are less likely to receive life-saving treatments than their white counterparts.

These procedures are proven to reduce fatalities and improve patients’ quality of life.

Still, the systemic racism found in many healthcare systems prevents minority communities from receiving this procedure, according to new research in the American Heart Association’s (AHA) Stroke. 

“As disparities in stroke care, in general, have been repeatedly and consistently demonstrated, I would say the results were not surprising, though they remain frustrating and concerning,” the study’s lead author, Dr. Lorenzo Rinaldo—a neurosurgeon at the Mayo Clinic—said in a press release.

About the Implicit Bias Study

Researchers at the Mayo Clinic examined 206,853 patient records from 173 medical centers nationwide.

They found that doctors only treat 16% of Latino and black patients with the clot-busting, gold-standard drug Alteplase — compared to 21% of white patients.

Another procedure, known as mechanical thrombectomy, allows doctors to thread a catheter through an artery using a clot-grabbing device to reach and remove the mass from the brain.

Around 7% of Latino or black patients received a mechanical thrombectomy; whereas approximately 10% of white patients did. Amongst those with Medicaid or who were uninsured, Latino or black patients were less likely to get the thrombectomy procedure than their white peers.

“Studies have repeatedly shown a difference in stroke care by race, but current research doesn’t delve into why,” Dr. Salvador Cruz-Flores, professor and chair of the Department of Neurology at Texas Tech University Health Sciences Center in El Paso, told AHA.

“As a medical community, we have tried to explain these differences biologically or based on a faulty system and have danced around the idea of implicit bias … and I suspect it’s because we don’t like to think of ourselves as prejudice or biased,” said Cruz-Flores, who was not involved in the new study.

Dr. Cruz-Flores also notes that studies have not been able to indicate exactly why treatment differences happen. He has tried to understand if they stem from biological and socioeconomic problems or if it could be prejudice and bias on the part of the providers.

Implicit Bias in Healthcare

Implicit bias in the healthcare setting is gaining national attention.

Studies have continuously indicated that doctors and other healthcare providers are often vulnerable to their unconscious bias, or otherwise known as implicit bias— automatic processing that is influenced by stereotypes, which then impact actions and judgments.

Due to implicit bias, many incorrect assumptions and adverse health outcomes persist, such as:

• Latino men are less likely to receive treatment for high-risk prostate cancer than White men. Uninsured non-Latino white men were 37% less likely to receive definitive treatment than those with insurance, and uninsured Latinos were 66% less likely to undergo definitive treatment compared to their insured counterparts.
• Latinas and other pregnant women of color face discrimination from healthcare providers. This is due not only due to their race, but their socioeconomic background as well.
• White male doctors are less likely to prescribe pain medications to black patients than white patients.
• Minorities who visit an emergency room in the U.S. are less likely to receive prescriptions for certain medications than Whites.

Now, stoke-care is on that list.

Even though the racial disparities in treatments were small in absolute terms, Cruz-Flores stated they were statistically significant because of the large group studied.

“Regardless of the size of the difference,” he said, “what will worry most of society is why the difference exists.”

What Can You Do to Address Implicit Bias?

The good news is you can “rewire” implicit bias toward more compassion for others.

Download the free Salud America! “Find Out If You Have Implicit Bias and What to Do Next” Action Pack.

This will guide you to see if you have implicit bias, reflect and learn from others who have overcome their own implicit bias, and encourage others to learn about implicit bias, too.

The Action Pack was created by Dr. Amelie G. Ramirez, director of Salud America! at UT Health San Antonio.

SEE IF YOU HAVE BIAS!