Doctors Biased by Patient's Race and Sex

If you have chest pain, the doctor's decision about your care may depend upon your race and sex.

A striking article in The New England Journal of Medicine in February, 1999 reported evaluations of 8 "patients." Each was wearing a hospital gown. Each was looking at the camera. A hospital bed was behind each "patient."

The 8 "patients" were interviewed. They followed the same script and described the same symptoms of chest pain. They had comparable occupations and comparable medical insurance. A videotape of the "patients" was subsequently shown to 720 doctors.

The only differences among the "patients" were their age (55 or 70), race (black or white) and sex. Four "patients" were 55 years old: a black woman, a white woman, a black man, and a white man. Likewise, 4 "patients" were age 70: a black woman, a white woman, a black man, and a white man.

Each of the 720 doctors was individually asked to estimate the likelihood that a "patient" had a narrowing of the coronary arteries and then, based on results of a stress test, to indicate whether the patient should be referred to a cardiologist (a heart specialist) for a cardiac catheterization.

The doctors, the results revealed, were 40% less likely to refer a black than a white for cardiac catheterization. The doctors were also 40% less likely to refer a woman than a man for catheterization.

The researchers conclude that "the race and sex of a patient independently influence how physicians manage chest pain." They add "decision making by physicians may be an important factor in explaining differences in the treatment of cardiovascular disease with respect to sex and race."

Why should it matter if you have chest pain whether you are a man and not a woman or white and not black?

The biases of doctors, the researchers suggest, may "represent overt prejudice" or, "more likely, could be the result of subconscious perceptions, rather than deliberate actions or thoughts."

Eliminating bias in health care in the U.S. is clearly needed. How to do it is less obvious.

Reference: Schulman KA, Berlin JA, Harless W, et al. The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization. N Engl J Med 1999;340:618-26.


Last Editorial Review: 2/1/2005




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