Wouldn’t it be great if all people in the United States received high quality health care, regardless of their race or sex? Unfortunately, the evidence suggests that there are biased or prejudicial attitudes among health care providers. On top of that, evidence suggests that those attitudes affect the quality of care black women receive. Here, we’ll look at some of this evidence. We’ll look at a study by Kevin A. Schulman, M.D. and others.
The Schuman study shows that doctors’ diagnostic and treatment decisions are influenced by a person’s race and gender, and that–if the goal is receiving good medical care for a heart condition–being born a black woman is a substantial disadvantage.
The Design of the Study
The study’s authors developed a computerized survey instrument to assess doctors’ recommendations for managing chest pain. Actors, unbeknownst to the doctors who participated in the study, portrayed patients with particular characteristics in scripted interviews about their symptoms. The patients varied only in race (black or white), sex, age (55 or 70 years), level of coronary risk, and the results of an exercise stress test. The patients followed the same script in describing their symptoms of chest pain, were clothed in an identical manner, and given comparable occupations and insurance status.
A total of 720 doctors at two national meetings of organizations of primary care doctors participated in the survey. The doctors were told that they would be taking part in a study of clinical decision making, but they were not told that the main purpose of the study was to determine the effect of a patient’s race and sex on the decision making.
Each doctor viewed a recorded interview and was given other data about a hypothetical patient. Then, each doctor was asked to estimate the likelihood that a patient had a narrowing of the coronary arteries and then, based on the results of a stress test, to say whether the patient should be referred to a cardiologist for cardiac catheterization.
The Results of the Study
The study’s authors analyzed the results to assess the effects of the race and sex of the patients on treatment recommendations, controlling for the doctors’ assessment of the probability of coronary artery disease as well as for the age of the patient, the level of coronary risk, the type of chest pain, and the results of an exercise stress test.
The results were clear. For the black patients, the study’s authors found that the doctors were less likely to refer such patients for catheterization.
How much less likely? The results suggested that blacks were 40% less likely than whites to be referred for catheterization.
However, in a rebuttal to this finding, a group of doctors argued that the 40% figure was overstating the case. Instead, they argued that the results showed that the probability of blacks being referred for cardiac catherization was 7% lower than for whites. They argued that significantly lower rates of referral were found only in the case of black women, whose rate of referral was about 12% less than the rate for white men, white women, and black men.
Let’s assume the doctors who made the rebuttal to the Schulman study were correct. Even assuming this, the study indicates that–to the detriment of black women–race and gender influence how doctors manage chest pain.
Considering that heart disease is the leading cause of death in the United States, the dangers of medical biases disfavoring black women are severe.
What can be done to counteract the biases that hurt black women?
One thing we as individuals can and
should do is hold doctors and other health care professionals accountable for
the errors they make. All too often individuals who are injured by health care
professionals never seek the help of a medical malpractice attorney.
Additionally, we can push lawmakers–especially those in blue states–to fix
medical malpractice laws; for example, in Maryland, we can push lawmakers to
lengthen the applicable statute of limitations and to eliminate the cap on damages
for pain and suffering. When black women receive inferior health care due to
racial biases, limiting their ability to sue and recover substantial damages
for the harm inferior care causes is a civil rights issue.
 The study formed the basis of a 1999 article in The New England Journal of Medicine, “The effect of race and sex on physicians’ recommendations for cardiac catheterization.”
 Cardiac catheterization is a procedure used to diagnose and treat certain cardiovascular conditions.