Study: Latino, Black Physicians Experience Racial Discrimination and Bias from Patients

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More than 40% of Latino and Black resident physicians experience racial discrimination and bias from the patients they serve, according to a study published in JAMA Network Open.

The experiences range from explicit racial epithets to a patient’s refusal of care.

And on top of that, most physicians (84%) do not report the incidents to their leadership.

“To address the issue of biased patient behavior, interventions are needed at the institutional and interpersonal levels,” according to researchers Shalila de Bourmont, Arun Burra, Sarah Nouri, et al.

Racial discrimination and implicit bias must be addressed.

What the JAMA Study Showed about Bias and Discrimination

The study conducted by de Bourmont, Burra, Nouri et al. surveyed 232 internal medicine residents from three different academic medical centers in California and North Carolina.

Researchers asked resident physicians about their experiences with biased patient behaviors and how they respond to them.

“The frequency and extent of specific biased patient behaviors varied substantially, with belittling comments experienced on a monthly or weekly basis by more than half the residents and bias-based requests to change physicians experienced a few times a year by one-third of residents,” according to Fierce Healthcare.

Here are some of the key data from the survey:

• 45% of Latino and Black physicians experienced racial epithets or refusal of care
• 87% of female physicians experienced sexual harassment by patients
• 40% of physicians witnessed discrimination against Muslim physicians
• All Asian physicians experienced bias from patients, specifically questioning their qualifications and confusing them with other Asian physicians

The study also found that 84% of resident physicians do not report these biased and discriminatory instances.

“Despite the problems, most residents (84%) do not report these encounters to institutional leadership, preferring instead to respond to incidences of patient bias on their own or debrief with friends, family, and team members,” according to Fierce Healthcare.

The Role of Implicit Bias

In such instances of racial discrimination, implicit bias is often at play.

Implicit bias is defined as preconceived notions, or stereotypes, that affect our understanding, actions, and decisions about others—at a level beyond our conscious control, according to a Salud America! research review.

Stereotypes like these then influence your actions and judgments:

• A widely held, simplified, and essentialist belief about a specific group (race and ethnicity, language, socioeconomic status, sex, and so forth).
• A pre-judgment of a person based on a group with which she/he may be associated.
• Tended to be set and oversimplified images or ideas.

“Implicit bias has a real-world effect on behavior,” according to the research review. “It impacts employment, education, healthcare, criminal justice, and more.”

It’s been well known that patients may experience implicit bias from physicians when at the doctor’s office.

“Implicit bias plays a huge role. According to the National Academy of Medicine, minorities are less likely than white persons to be given appropriate cardiac care, to receive kidney dialysis or transplants, and to receive the best treatments for stroke, cancer, or AIDS,” writes Samantha Olds Frey, CEO for Illinois Association of Medicaid Health Plans, in an op-ed for the Chicago Defender.

Many studies have shown that physicians—especially white physicians—have implicit, subconscious preferences for white patients over those of color.

“Implicit biases may impact the ways in which clinicians and other health care professionals diagnose and treat people of color, leading to worse outcomes,” say researchers Nao Hagiwara and Tiffany Green in Scientific American.

How Can Hospitals Support Latino Physicians Experiencing Bias?

Implicit bias has severe consequences for Latinos and other people of color.

Fortunately, we can try to combat it.

The JAMA Open Network study described several ways that hospitals can support physicians of color and handle future discriminatory incidents.

“Developing a deeper understanding of residents’ sense of futility in responding to bias will be necessary for effective development and implementation of trainings and policies,” the study authors said.

The authors also recommend giving physicians the resources to handle biased patients.

“On an interpersonal level, training on dealing with biased patients should be incorporated into resident and faculty development curricula,” according to the study.

Implicit bias is starting to be addressed at health care facilities across the country.

Several states have moved to require implicit bias training for health care professionals in the hopes of addressing racial inequities.

In July, Michigan Governor Gretchen Whitmer signed a bill to mandate implicit bias training in health care across her state. Officials in California have taken similar steps to address the disproportionate maternal mortality that Black women face. Physicians in Illinois are lobbying for a bill that would require health care professionals to take an implicit bias training course.

How Can You Tackle Implicit Bias in Your own Life?

Seek training or help put an end to microaggressions.

In the healthcare field, teach cultural competencies and cultivate more doctors of color to help produce better outcomes for Latino patients.

Check out stories of people who are overcoming biases:

• Dr. Rogelio Saenz overcame implicit bias growing up and in his career. He became a well-respected UT San Antonio researcher using data and demographics to set up social justice solutions.
• Dr. Jabraan Pasha created a training workshop to spread awareness of implicit bias in healthcare.
• Denise Hernández recognized how implicit bias was holding her back from embracing her Chicana culture and heritage.

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!