Unconscious racial and gender biases impact the patient treatment process
Physicians can manifest their biases about a patient without realizing it. This can strain the doctor-patient relationship.

Racism and discrimination in medicine is an ongoing concern. According to research on the Department of Veterans Affairs health care system, Black veterans are less likely to be offered treatment options than their white counterparts for similar diseases, raising the timely question of social disparities in health access and outcomes. 

The 2012 study, “The Role of Unconscious Bias in Surgical Safety and Outcomes” was conducted by general surgeons Heena P. Santry and Sherry M. Wren at Ohio State University Wexner Medical Center and Palo Alto Veterans Hospital, respectively. They concluded that physicians are not always aware of the gender, ethnic, and racial stereotypes that impact their decision making and, in turn, a person’s quality of life: “Unconscious bias occurs as part of normal cognitive processing where people’s implicit associations can influence their responses to certain tasks, scenarios, medical encounters, and so forth.” 

Unconscious bias can manifest in the forms of negative body language and dominant communication styles. It presents itself from the onset of the patient treatment process when the patient-physician relationship is established at the first office visit. 

In response to the physical manifestations of doctor bias, older Black women need “to behave more aggressively to warrant a more complete staging work-up [for breast cancer] compared with older white women,” Santry and Wren say

In 2017, associate professor in the School of Social Welfare at the University of California, Berkley, Tina K. Sacks, published a study in Critical Public Health. The study reaffirmed the need Black women feel “to perform, jockey, or otherwise fight for recognition” when it comes to not only specialty care, but other concerns such as pain management. 

Sacks interviewed 19 middle-class Black women about their general healthcare and discrimination experiences. Sacks found that participants anticipated race and gender bias in their clinical interactions because of commonly held stereotypes of Black women: namely, that they are angry, “welfare queens”, or prostitutes. To counter this, they behave in ways that help mitigate the discrimination that leads to differences in treatment and the subsequent risk of mental health problems. 

To be taken seriously, the participants reported dressing well to communicate social privilege and material resources when they visit the doctor’s office. To convey their medical problems rationally and concisely for the most accurate solutions, participants did their own research before appointments. To meet healthcare providers’ “particular expectations of what makes a capable and proficient patient,” they emphasized their professional and educational credentials. To appear worthy of quality care, they tried to make personal connections with providers. Clearly, “the onus is on the patient to be aggressive,” said one a respondent, a 59-year-old married woman with a doctorate in Divinity, about their efforts to present themselves as individuals in need of care rather than a stereotype.

Perceptions of discrimination lead to medical distrust and compromises the shared decision-making process (SDM). SDM is a collaborative process between physicians and their patients wherein information the patient provides and recommendations from the physician combine to determine the quality and number of procedures to follow. 

As stated by Santry and Wren, physicians can reduce unconscious bias and improve surgical safety by learning to recognize, with a socioeconomic perspective, prejudice in their work. They argue that SDM and making physicians more aware of their unconscious biases encourages an informed and inclusive approach to clinical practice. 

Sports & Health Editor (Volume 49)| sports@themedium.ca — Alisa is a third-year student completing a major in Professional Writing and Communication with a double minor in Political Science and Cinema Studies. She served as Editor-in-Chief of Mindwaves Volume 15 and Compass Volume 9 and was a recipient of the Harold Sonny Ladoo Book Prize for Creative Writing at UTM. Her personal essay, “In Pieces,” appears in the summer 2020 issue of The Puritan. In 2022, she published her first poetry chapbook, Post-Funeral Dance, with Anstruther Press and wrote for The Newcomer as a journalist. When Alisa isn’t writing, she’s probably reading historical nonfiction, ugly-crying over a sad K-drama, or dreaming of places far, far away.


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