Doctors and Bias

Doctors are always right, right? We wish doctors were perfect. Doctors can make incorrect medical decisions, and sometimes these incorrect medical decisions or treatment plans result from underlying implicit biases. Unfortunately, doctors are just like us, and are influenced by the same culture and implicit biases.

Implicit biases (click on link to read more about implicit biases) are subconscious beliefs developed over the course of our lives due to the culmination of media consumption, personal experiences, culture, and upbringing that leads our brains to associate certain people/groups/objects with specific ideas. For example, everyone living in the United States (US), including doctors, has grown to develop implicit biases against particular races, sexes, genders, sexualities, pre-existing physical conditions etc. based on US culture and media regardless of one’s personal ideologies.

As a result, the same implicit biases that influence our decisions also influence doctors. Because doctors make medical decisions based not only on their patients’ physical symptoms but also perceptions of their patients and the patients’ well-beings, doctors’ medical decisions are inevitably subjective. Doctors’ decisions are therefore subjected to implicit biases. Consequently, a patient’s course of treatment and quality of care can unfortunately be skewed based on cultural implicit biases.

But, doctors are trained professionals, so they are educated to provide the best and unbiased care for their patients right? Unfortunately numerous studies have reported that implicit biases can result in worse health outcomes, reduced trust and communication with doctors, and increased costs, especially for racial/ethnic minorities, LGBTQ people, women, the disabled, children, obese patients, or those on the spectrum.

For example…

1. False beliefs that Black and white people are biologically and fundamentally different have persisted for centuries. Misconceptions, such as Black people have a higher pain tolerance than white people, have resulted from these beliefs and still influence modern day ideas and perceptions of Blacks, even doctors’ perceptions. Multiple studies have demonstrated biases and disparities in pain management treatment between whites and Blacks. For example, one study showed that physicians were twice as likely to underestimate Black patients’ pain compared to all other ethnicities.

2. Gender disparities in utilization of cardiac tests have been well documented. Doctors are less likely to recommend subsequent testing for female patients who had abnormal cardiac tests versus males due to a bias that males are more likely to engage in risky behaviors (behaviors that increase risk of disease such as alcoholism and tobacco usage). A recent study examined the relation between gender implicit bias and its impact on medical decisions for recommending heart disease diagnostic tests and demonstrated implicit gender bias in cardiologists that could be the cause of differential treatment plans between male and female patients presenting the same symptoms. The study also found that female physicians had significantly less bias for risk taking behaviors over males and females in comparison to their male counterparts.

While it is very concerning that implicit biases will negatively impact the livelihood of patients subjected by these biases, new legislation and programs (2020) to combat health care disparities due to implicit biases. For example, California’s new legislation to require hospitals and birth facilities to implement implicit bias programs and John Hopkins School of Medicine’s new anti-bias training provides hope for a movement toward healthcare equity and non-biased patient care.