Could Doctor Bias Be Affecting Your Treatment?

By Ashley Hayes
WebMD Health News

Reviewed by Hansa D. Bhargava, MD

Jan. 13, 2016 -- Your emotional state, your weight, and even your intelligence or insurance coverage may affect the way your doctor perceives you, according to a Medscape survey of more than 15,800 doctors.

Four in 10 doctors admit they have some degree of bias, or prejudice, toward specific types or groups of patients, according to the survey conducted by WebMD's site for health care professionals. Doctors from 25 specialties responded to the survey, which is part of Medscape's annual Physician Lifestyle Report.

Of those that do admit to biases, the two most common triggers were patients':

  • Emotional problems (62%)
  • Weight (52%)
  • Intelligence (44%)
  • Language differences (32%)
  • Insurance coverage (23%)

When doctors were asked to include other triggers not listed on the survey, many cited drug-seeking by patients, drug abuse, malingering (meaning pretending to be ill or exaggerating it), patient noncompliance, and patients with chronic pain.

Doctors most likely to admit to some degree of bias include:

  • Emergency room doctors (62%)
  • Orthopedists (50%)
  • Psychiatrists (48%)
  • Family doctors and OB/GYNs (47%)

Pathologists, radiologists, and cardiologists were the least likely to say they make preconceived judgments. And the survey found a link between bias and doctor burnout -- defined as "loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment." Overall, 55% of doctors who said they are burned out also said they held biases.

"Bias is never a good thing, but when we consider the doctors who hold the most bias also tend to be unhappy on the job and burned out by medical practice, we have a better understanding of the problem," says Michael W. Smith, MD, WebMD's chief medical editor.

One survey limitation is that of "implicit" or unconscious bias, which may affect treatment even if a doctor is not aware of it. But, as one doctor responding to the survey said, "while my subconscious attitudes and perceptions may be affected, I check these at the door and do my best to be empathetic no matter what."

A small percentage of doctors who admitted bias in the survey said it actually affects their care of patients -- 14% of emergency room doctors, for example, and 12% of plastic surgeons. And the effect of bias on treatment can be positive, negative, or both. One-quarter of those whose perceptions of their patients affect treatment said they tend to overcompensate and give patients special care, while 29% said the treatment effects were negative.

"Thankfully, few doctors let bias affect the care of their patients," Smith says. "But it's still a troubling trend."

Younger doctors, ages 35 and under, were the most likely to admit to prejudices, at 50%. The percentage falls with age, with 30% of doctors aged 66 or older saying they could be biased.

The greatest percentage of doctors admitting bias was in the Northwest (49%), with slightly lower percentages seen in the West and Southwest. In the Northeast, Mid-Atlantic, and Southeast, 37% of doctors said they made preconceived judgments. Doctors who said they are socially liberal reported higher percentages of bias than those who said they're socially conservative.

Meanwhile, the report seems to indicate burnout is a growing problem among doctors. In the 2016 report, doctors said they feel even greater effects of it than in years past.

Specialties with the highest rates of burnout included:

Women were more likely to report burnout than men (55% and 46%, respectively). Doctors say bureaucratic tasks and long working hours are among the leading causes of the problem.

"Doctors are more burned out than other American workers, and we see this number go up year after year in the Medscape Lifestyle Report," Smith says. "It's reaching critical levels, with the number of doctors and the severity of burnout increasing in every medical specialty."

Some other findings from this year's report, the fifth from Medscape:

  • About one-quarter of doctors claim to have ever smoked marijuana. That is unchanged from the 2015 report (the first year questions regarding marijuana use were included). The heaviest use in both years was reported among doctors aged 56 to 65 years, at about a third.
  • Doctors who prescribe medical pot said they most often do so for pain management (61%). Others said they prescribe it for multiple sclerosis (17%), glaucoma (10%), and inflammatory bowel disease (7%).
  • Twenty-six percent of women doctors claimed they're happy at work, compared to one-third of men.
  • Dermatologists and ophthalmologists claimed the highest levels of work happiness, at 39% and 38%.
  • Both men and women doctors reported about the same happiness levels at home (60% and 59%).
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References
SOURCES: Medscape Physician Survey, September-December 2015. Margin of error +/-0.78% at a 95% confidence level. Michael W. Smith, MD, WebMD chief medical editor.

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