Bias, Burnout, Race: What Physicians Told Us About the Issues

Carol Peckham

Disclosures

January 10, 2017

In This Article

Physician Bias

In response to questions about bias in the current Medscape survey, fully half of physicians reported that they had biases toward specific types or groups of patients.

It should be pointed out that one limitation of the Medscape survey is the issue of implicit bias, which occurs without conscious awareness. Frequently at odds with one's personal beliefs, implicit bias can unwittingly perpetuate disparities and is more likely to be positive toward whites and negative toward non-whites,[18,19] A 2012 study of primary care physicians used a computer-based tool to assess implicit bias.[20,21] While no overt bias was detected, physicians had a moderate implicit bias toward blacks, associating their white patients with greater compliance.

Bias and Gender

When physicians who admitted biases were asked to characterize them, there were no great differences between genders, except perhaps in regard to bias toward patients with heavier weight. More than half (51%) of male physicians, compared with 42% of female physicians, cited overweight as a patient factor that elicited bias. Emotional problems in patients was the most frequently cited bias-eliciting characteristic among female respondents (51%) and was nearly matched among their male counterparts (50%). Perceived low intelligence ranked third as a bias trigger for both genders (40% of men and 38% of women), followed by language differences (28% of men and 26% of women). Nearly a quarter of men (21%) but a smaller percentage of women (15%) reported bias toward patients who lack insurance. Ten percent of male and 9% of female physicians expressed bias toward patients of race different from their own, and only 4% of female and 5% of male physicians reported bias toward patients of a different gender.

Bias and Race/Ethnicity

Just over half of black/African American physicians (56%) admitted to bias, compared with a slightly lower 53% of white/Caucasian and 52% of Hispanic/Latino physicians. A higher percentage of physicians who identified themselves as Korean or Vietnamese reported that they had biases (63% and 60%, respectively). The lowest percentages occurred among Asian Indians and other Asians (34% and 41%, respectively).

In a study of primary care physicians on implicit bias, 48% of participants were white, 22% were black, and 30% were Asian. White and Asian physicians tended to be more positive in their interactions with white patients, while black professionals were mostly neutral.[21]

Effect of Bias on Treatment

The Medscape survey also asked whether biases affected treatment—positively, negatively, or both. Only 16% of all physicians who admitted having bias said that it did. Our survey asked that group whether the effect of their bias was positive (eg, extra time spent, friendlier manner) or negative (eg, less time spent, less friendly manner), and respondents could answer "yes" to both questions. The highest percentages of physicians who admitted to negative effects on treatment of patients as a result of bias cited language differences (61%) and emotional problems (58%). Half acknowledged a negative disposition toward those who are overweight, 49% toward those who they perceived to have low intelligence, and 45% toward those who lack insurance. The only bias that about half of respondents said leads to positive treatment is older age.

In spite of the relatively low percentage of physicians who said that their biases affect treatment, evidence does suggest that bias can affect attitude and, by extension, care. In one study, although implicit bias did not have a direct effect on treatment recommendations, physicians were more likely to find white patients "cooperative" than black patients, which could have influenced their decisions.[22] A 2012 study[21] of primary care physicians suggested that implicit bias was linked to the way physicians communicated with their patients. Office visits for black patients were 20% longer and with a slower-paced dialogue, while white patients had visits that were 20% shorter and with faster dialogue. An analysis of studies on the relationship between patients' race/ethnicity and care found that there was greater overuse of care among white patients.[23] A 2015 study of surgeons did not find an association with clinical decision-making in spite of unconscious social class and race biases, although the authors advised further studies on real physician-patient interactions.[24]

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