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Health & Wellness

How racism and bias can affect health care decisions, and what can be done about it

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Unconscious bias about someone's race, ethnicity, gender, sexual orientation, age, weight, and other characteristics can play a factor in what kind of treatment that person gets.

Health care providers are supposed to help us get well or keep us well. But a doctor who’s studied the issue says bias and racism in decisions about treatment can affect the outcome.

Dr. Quinn Capers is an interventional cardiologist at UT Southwestern Medical Center. He's also associate dean for faculty diversity and vice chair for diversity and inclusion.

He told KERA’s Sam Baker hundreds of studies of hospitals across the country clearly show bias and racism at work.

INTERVIEW HIGHLIGHTS:

How racism and bias can impact health care decisions

You know, doctors are human, too. And so we have these unconscious biases where we ascribe certain characteristics to people based on what we see: Race, height, age, weight. What we perceive their religion to be, et cetera. And if in our mind we ascribe something negative to that demographic that we're seeing that can influence our behavior.

For example…

So, for instance, studies have shown that doctors who take a certain online test tend to ascribe non-compliance or being less cooperative with Black and Hispanic patients. And so if I'm a doctor in a situation to treat you, and there is a therapy that requires strict adherence and you've got to follow the rules. If in my even unconscious mind, I see that you are a man of color, you're a Black man. And if my mind says, well, Black people are usually less compliant, then I might not even offer that therapy. So that's one example of how that can go. 

A paper you co-authored and published in 2020 suggested ways to reduce bias in hospitals, like increasing diversity on decision-making bodies — who gets a transplant, for instance.

One problem struck me as interesting and odd: How does burnout and sleep deprivation contribute to bias in health care decisions?

Our unconscious biases tend to take over when we are exhausted, times when we’re tired, times when we are thinking of two or three things at once. The brain is overloaded, and that's when reflexive unconscious biases take over.

So the doctor who is sleep-deprived, called in different directions, the beeper keeps going off: That doctor is at risk for their biases really driving the bus in terms of their behavior. 

You also suggested “bias and racism rounds” as a way to alleviate bias in hospitals. How does this work?

What we plan to do is get the inpatient care team together quarterly for a teaching session where we review instances where we think that the patient care was impacted by bias.

The intent is not to be punitive. So we de-identify all of that. But we talk about case vignettes. We have a conversation about them. And the outcome is, listen, none of us are perfect. We're striving to be better, but we can't have this bias impacting our patient care. So here are some things that have happened. And what do we need to do to make sure it doesn't happen in the next three months.

Are the participants ever shocked at what they learn about themselves?

Yes. But what's important is that it's done in the right way so that people don't feel like you're blaming them or you're going to punish them. The tone of this is for educational purposes and we want to do better.

Do you worry that making people more aware of racism and bias gives them more reason to avoid the health care system? 

A person or two mentioned that to me, and I'm actually hoping for the opposite. I'm hoping patients will realize there's bias in the banking system, educational system, and criminal justice system. So, of course, there’s bias in the health care system. But it looks like they want to do something about it.

That's the outcome that we're hoping for.

RESOURCES:

A Black doctor at UT Southwestern speaks out on health care’s racial bias: ‘Our hands are not clean’

Bias and Racism Teaching Rounds at an Academic Medical Center

Got a tip? Email Sam Baker at sbaker@kera.org. You can follow Sam on Twitter @srbkera.

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