Exposing deadly attitudes
Date: January 10, 2012
Trauma surgeon Adil Haider believes that saving lives in Hopkins’ emergency department also means confronting forms of racial and class bias. As one of many Hopkins researchers studying inequality in medical care, he is helping to identify disparities in how trauma providers treat their patients.
Using national databases, Haider and his research colleagues have shown that being black, Hispanic or uninsured significantly increases the chances of death for anyone entering the emergency department; an insured white person with similar injuries, on the other hand, is more likely to recover.
Now the associate professor of surgery is examining how the unconscious racial and class preferences of 500 trauma care providers at Hopkins may influence their treatment decisions. It is one of few such studies to include nurses.
“Nurses have a very important and prime role in how we take care of people,” Haider notes. “If the nurse says I think this poor guy is really suffering in pain, for instance, then the doctor will probably take that into account when deciding how much medication to give.”
Previous studies using a validated “association test” show that roughly 70 percent of the general population has an implicit preference for white people. Such unconscious biases in physicians are affiliated with treatment approaches. One study, for instance, showed that doctors who are unconsciously partial to white people were less apt to treat black heart patients with clot-busting drugs.
Now Haider has evidence that these doctors may have assessed patients differently when they were younger. His research, published in September in the Journal of the American Medical Association, questions whether medical students somehow “learn” to treat non-white and disadvantaged patients differently during the course of their education.
In a confidential, Web-based survey, first-year Hopkins medical students were given questions about how they would handle theoretical situations concerning patients from different races and social classes. Later they took the Implicit Association Test, a standard measure used to uncover unconscious attitudes.
“We found that medical students, just like the general population, had unconscious preferences,” Haider says. “But unlike doctors whose unconscious preferences were associated with how they treated patients, the medical students assessed patients independently.”
This discovery raises another question: Are medical schools and residencies training students in a way that leads them to act on their biases?
Haider points out that learning medicine already requires stereotyping: “We teach that if your blood pressure is low and your heart rate is high and you’re also injured, that probably means you’re going into shock,” he says. “Maybe we’re unknowingly also teaching students to stereotype certain people.”
In fact, he hopes that is the case. “The whole trouble with disparities is we don’t know exactly why they occur,” he says. “So if this is one of the mechanisms, I’m glad we’ve found it. It means there’s something we can do about it.”