Physicians have a long history of discriminating against patients, and racial discrimination only scratches the surface of current problems facing patients who seek access to care. The Tuskegee Syphilis trials demonstrated how the medical community exploited and compromised the trust of African American patients. Recent research indicates that out of a study of 222 residents and medical students, about half demonstrated false beliefs concerning biological differences between white and black patients.
Interestingly, among those that demonstrated these beliefs, it was shown that they undertreat the pain of black patients. Those who did not demonstrate these beliefs were found to treat patients appropriately in case scenarios regardless of race. This study is consistent with findings concerning minority health disparities. While the majority of physicians are not consciously or overtly racist or prejudiced, there is a clear unconscious bias that can occur. Simple consciousness of these biased behaviors can have a lasting impact on the health of minority patients.
While outcomes may not be as severely negative as with some minorities, women have also been found to have substantial discrimination in relation to the treatment of their pain and myths concerning the ability of women to withstand pain are rampant in the decision-making process. The concepts that women have a natural ability to sustain pain due to the rigors of childbirth and have strong coping mechanisms for suffering permeate medicine. Furthermore, women are more likely to have their pain listed as psychogenic or emotional in nature. Women have an increased risk of being misdiagnosed, sometimes with deadly consequences due to presenting “atypically” from traditional symptoms. Most women will not present with chest pain during an acute coronary syndrome leading to delays in appropriate treatment. There are steps being taken to overcome these oversights in medicine, however much remains to be addressed. There are efforts to incorporate sex-specific curricula into medical schools, such as the Laura Bush Institute for Women’s Health in Texas. While the effects of this curriculum and change in mindset may take time to become mainstream, the alternative of single-gender medicine as a one size fits all is hardly the gold standard of medical care.
Another sizeable group that is overlooked in terms of health care outcomes are the disabled. Disabled patients comprise over 12 percent of the population, and, unfortunately, many disadvantages exist that lead to worse health outcomes compared to the general population. It has been an uphill battle to adequately fund social services available to the disabled and transition pediatric services to adolescent and adult care. As such, persons with disabilities routinely have higher rates of chronic illness, and they are less like to receive preventative care such as mammograms and pap smears, leading to worse overall outcomes. In a study, it was shown that about one-fifth of medical offices were unable to schedule a typical fictional patient who uses a wheelchair with a history of stroke. Reasons to accommodate disabled patients, although illegal, include lack of wheelchair accessible ramps for entry, inadequate patient transfer lifts or even bariatric scales. Allowing greater financial support for offices obligated to treat disabled persons, as well as global training of medical staff regarding management of disabled persons would assist with bridging these gaps.
Aside from the visible forms of discrimination, physicians are known to discriminate against patients with certain diagnoses, including mental health or substance use. This is a type of discrimination that can only happen with medical staff since it requires being privy to a patient’s medical history. Patient profiling and diagnostic overshadowing are described as a hidden human rights emergency, according to the World Health Organizations Quality Rights Project. This patient profiling of those with psychiatric illness has led to adverse outcomes in those with mental health conditions due to the routine underutilization of screening and treatment guidelines. Diagnosis of multiple mental health conditions causes patients to die twenty-five years earlier than the general population. While some of this is due to suicide, over 60 percent is due to preventable conditions.
Regardless of whether discrimination is by physicians or by patients, medical clinicians can improve outcomes in any patient population by creating awareness and understanding our own biases and the consequences they lead to in relation to patient care. Simple consciousness and mindfulness can lead to improved patient outcomes along with greater fulfillment when physicians are meeting patients where they are and are capable of working with difficult cases. Current efforts have been made to create a relationship of trust and respect toward patients, and this needs to continue given the historical framework of disadvantaged patient populations. This effort, in turn, will lead to improved physician training and reduce physician burnout.
Sheila Ramanathan is a family physician. This article originally appeared in the New York State Academy of Family Physicians’ Family Doctor.
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