Study: Bias Among Doctors

(As reported 2/25/99)
New research reported in the New England Journal of Medicine shows there may be significant differences in the medical treatment women and African Americans receive compared to white men.

The study of 720 physicians revealed that differences in care might be attributable to doctors' subconscious prejudices, not financial barriers, a patient's preferences, medical condition, or access to care, as concluded in previous studies.

Researchers found that, with all symptoms being equal, doctors were more than twice as likely to order a routine but crucial diagnostic test for white men than they were for female or black patients. Black women fared the worst. Just four in ten received Cardiac Catheterization, a procedure considered the gold standard for diagnosing heart disease.

Because doctors knew their decisions were being recorded, "most likely this is an underestimate of what's occurring," says Dr. Kevin Schulman of Georgetown University Medical Center.

Doctors attending medical conferences were told they were participating in a study of clinical decision making. They viewed medical data and a taped interview with one of eight patients. The patients were actually actors who described identical symptoms.

Information such as insurance coverage, profession and results of heart stress tests, were uniform among all the patients. Still, researchers found serious disparities in treatment recommendations.

"We still need to understand a lot more about why these differences occur," Schulman says of the doctors participating in the study. "This may all be subconscious (prejudice)."

Previous studies have found higher death rates among African Americans with heart ailments, but cite differences in disease severity and access to medical care as mitigating factors. In light of the new research, the medical community may now find itself reassessing those conclusions.