So there was some actual primary research on this topic in my to-read pile after all!
Study design: IM and EM residents were shown and asked questions about a clinical vignette about a middle-aged man with chest pain, shown along with a photo of a Caucasian or African-American patient. To assess unconscious racial bias, they took implicit association tests; they also filled out questionnaires about their attitudes to different racial groups.
Results: of patients who were thought highly likely to have CAD, black patients were offered thrombolysis at a lower rate (PCI wasn’t an option in this scenario). Physicians with more implicit bias shown on the IATs were less likely to offer thrombolysis if the patient was African-American.
Unlike the other papers we looked at this week, this one suggests that it’s not just class, or environment, or whatever that creates health disparities: there’s a component of racism/stereotypes too, however unconsciously, and it’s on the part of providers. That’s a much harder thing for us as doctors to acknowledge. Who knows what the relative contributions are, but definitely something to keep in mind as we interact with patients. Interestingly, the analysis initially excluded the participants who had figured out what the study was about. But then when they looked at those participants separately, the ones with higher measures of implicit bias had actually overcorrected and offered thrombolysis to the patient at higher rates. So being aware of it goes a long way toward equalizing our approach to care.