Racial Bias May Affect How Doctors Prescribe Pain Treatment

Racial Bias May Affect How Doctors Prescribe Pain Treatment

Pediatricians who show an unconscious preference for white patients tend to prescribe better pain management for whites than African-American patients, according to a study at the University of Washington.

“We’re talking about subtle, unconscious attitudes that are pervasive in society. Because these are unconscious attitudes, doctors aren’t aware that their racial attitudes may affect their treatment decisions,” said Janice Sabin, a UW research assistant professor in the Department of Biomedical Informatics and Medical Education, a part of UW’s School of Medicine. She is lead author of the study published in the American Journal of Public Health.

“Coupled with known racial and ethnic disparities in health care, our findings suggest that well-meaning physicians may unconsciously treat people differently in some areas of care,” said Sabin.

Eighty-six pediatricians who participated in the study completed tests to measure their unconscious attitudes and beliefs. The tests asked participants to quickly classify several series of words or visual images as they appear on a computer screen. Researchers say how quickly a participant responds to various instructions can reveal operating biases.

Sabin chose four conditions commonly treated by pediatricians: asthma, attention deficit hyperactivity disorder (ADHD), urinary tract infections and pain. Case scenarios were created for each condition for both an African-American and a white patient.

For the asthma, ADHD and urinary tract infections, doctors showed no association between treatment decisions for the two patients. However, recommendations for pain treatment decreased for African American patients when compared to those for white patients.

“Implicit biases are surprisingly pervasive, and in certain circumstances they can affect how people behave,” Sabin said. She said her findings “indicate that more research should be done to see if unconscious biases affect real-world medical care and treatment decisions, especially for pain management.”

Sabin’s previous research showed that pediatricians display less unconscious racial bias than other medical doctors or the general population. Still, unconscious beliefs can affect how doctors interact with patients, and the current study reveals that those attitudes can influence pediatricians’ treatment decisions.

A recent study at the University of Michigan found that living in poor neighborhoods worsens the symptoms of chronic pain and that African Americans, especially young adults, had significantly more pain and disability no matter where they lived.

Authored by: Pat Anson, Editor