Bias in Healthcare

Video

Medical practicioners are committed to equal treatment, but data still show disparities. Learn how to subvert bias to make treatment more equitable.

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Some California hospitals now quantify blood loss after birth by weighing the blood-soaked sponges and pads on a scale. This makes decisions clear for doctors: if a patient is bleeding too much, the scale will say so. Protocols like these have helped California cut its maternal mortality rate by more than half since 2006. Learn more about addressing gender and race disparities in medicine by watching John Oliver’s commentary on Bias in Medicine.

Can artificial intelligence help doctors provide more accurate treatment recommendations? Possibly. Given X-rays of arthritis patients, an algorithm picked up on subtle features that human eyes missed. Even in X-rays deemed “similar” by radiologists, the algorithm found slight differences that helped explain why Black patients were reporting more knee pain than White patients. Read more about the research at BBC News.

“Black and brown patients are systematically undertreated for pain. When treating pain from broken bones to appendicitis, [doctors] give darker-skinned patients, including children, lower doses of analgesics than do white patients, less potent medicine, or nothing at all.” Part of this bias stems from training: many doctors have “heard or been formally taught that Black people don’t feel pain as acutely as white people because they have different biology”. Often – but not always – well-intentioned, race-based medicine influences how U.S. clinicians assess risk, diagnose, treat, and monitor health conditions. But given how race is widely acknowledged as a social construct, should it? Consider the arguments in Stephanie Dutchen’s “Field Correction” at Harvard Medicine.

Pain management is an important part of healthcare, but access to opioids and pain medication is not equal. Across 310 healthcare systems, researchers found a striking discrepancy in the opioid dosage prescribed to patients: Black patients received a mean annual dose that was 36% lower than that given to White patients. We don’t know for sure what’s causing this disparity – are black patients under-medicated, or are white patients over-medicated? Regardless of the ultimate cause, “skin color should not influence the receipt of pain treatment.” Learn more at Patient Engagement HIT.

“Toward more equitable treatment of pain: Addressing bias is not simple, but it is essential, and there are steps that individuals and institutions can take.” Read Dr. Janice Sabin’s recommendations for equalizing medical treatment at The Association of American Medical Colleges. 

When women report pain, are their symptoms treated as seriously as men’s? Unfortunately, probably not. When asked to rate the pain of a patient in a video, participants in a study consistently underestimated the amount of pain a woman reported she was experiencing while overestimating the reported pain of a man. This bias in pain perception extends to doctors as well – women are consistently judged to be in less pain than men and to exaggerate their pain. Read more about the research at The Conversation.

References

Goyal, M. K., Kuppermann, N., Cleary, S. D., Teach, S. J., & Chamberlain, J. M. (2015). Racial disparities in pain management of children with appendicitis in emergency departments. JAMA pediatrics, 169(11), 996-1002.

Hackel, L. M., Looser, C. E., & Van Bavel, J. J. (2014). Group membership alters the threshold for mind perception: The role of social identity, collective identification, and intergroup threat. Journal of Experimental Social Psychology, 52, 15-23.

Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences, 113(16), 4296-4301.

Krumhuber, E. G., Swiderska, A., Tsankova, E., Kamble, S. V., & Kappas, A. (2015). Real or artificial? Intergroup biases in mind perception in a cross-cultural perspective. PloS one, 10(9), e0137840.

Lee, P., Le Saux, M., Siegel, R., Goyal, M., Chen, C., Ma, Y., & Meltzer, A. C. (2019). Racial and ethnic disparities in the management of acute pain in US emergency departments: meta-analysis and systematic review. The American journal of emergency medicine, 37(9), 1770-1777.

Looser, C. E., & Wheatley, T. (2010). The tipping point of animacy: How, when, and where we perceive life in a face. Psychological science, 21(12), 1854-1862.

Meghani, S. H., Byun, E., & Gallagher, R. M. (2012). Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States. Pain Medicine, 13(2), 150-174.

Trawalter, S., Hoffman, K. M., & Waytz, A. (2012). Racial bias in perceptions of others’ pain. PloS one, 7(11), e48546.

Credits

“Bias in Healthcare” was created and developed by Olivia Kang, Alex Sanchez, Evan Younger, Caitlyn Finton, and Mahzarin Banaji. Support for Outsmarting Human Minds comes from Harvard University and PwC.

Narration by Olivia Kang.

Animation and Editing by Evan Younger.

Images by Olivia Kang and Evan Younger, and adapted via Unsplash.

Music by Terry Devine-King, John Ashton Thomas, and Philip Guyler via Audio Network.

© 2021 President and Fellows of Harvard College