COVID-19 has exposed the racial differences in healthcare access and outcomes, with Black people experiencing greater morbidity and mortality from the disease compared with White people. In Michigan, Black patients were 133% more likely to contract COVID-19 than White patients and they accounted for 40% of all COVID-19-related deaths even though they account for 15% of the population, according to a Brookings Institution report. In areas including Chicago, New Orleans and Milwaukee, Black individuals accounted for 70% of coronavirus deaths.
Disparities in health have been cited in a range of conditions from diabetes and heart disease to infant mortality and colorectal cancer. Though social determinants such as food availability, safe housing, and income play a role in these disparities, inherent bias among physicians contributes to the way they offer and deliver treatment.
Jonas Attilus, MD, who is Black, can attest to the presence of inherent bias. He related an incident at Boston Medical Center, where he is an internal medicine resident, in which a woman walked by him and said, “I know you are on your break, but there is no soap in the women’s bathroom.” Dr Attilus said he was surprised but not necessarily offended by her assumption he was a janitor. “To her, being black and a doctor didn’t mix,” he said.
That woman, who was probably a patient’s family member, likely would not have thought of herself as racist, but she clearly had assumptions about him based on the color of his skin. And doctors likely do make assumptions about patients as well. Some people propose to increase the number of minorities in medicine to address this issue, but he said he would like to see anti-racist curricula be part of physician training.
“Where you grew up, people you hung out with probably had a sense of bias and that sticks with you,” Dr Attilus said. “By the time you start working with people, you have those biases.”
Health complications related to diabetes is among the health issues for which bias is present in patient care, he said. Noting that Black people are diagnosed with diabetes more than twice as often as White people and tend to have worse outcomes, Dr Attilus said, “Doctors may think Black people have more diabetes so they must not be healthy. But what about not having access to care, transportation or living in a food desert or having a lack of money to care for themselves like they should?”
Bias is not just limited to skin color. It can be in the form of assumptions physicians might make about patients. A patient who Dr Attilus had to care for had been hospitalized several times over the last years for only a single reason: alcohol withdrawal. Each time he saw the patient, Dr Attilus was frustrated that the man clearly was not learning a lesson: stay away from alcohol. But eventually he came to the conclusion that the patient had to know his behavior was not good for him, but that there were reasons he was using alcohol aside from ignorance about its detrimental health effects.
“Everyone really wants to take care of themselves in the end, and we judge people too quickly,” he said. “We base it on our own perception of them instead of their daily reality. Who are we to judge them? We don’t ask ourselves if those people have options,” he said. “Sometimes even when they have the money, they can’t get care because they are paying bills. Healthcare becomes a second priority for them.”
Doctors have good jobs and are paid well, and they have been educated on nutrition and exercise, Dr Attilus said. Physicians should not pass judgment on patients who may not have the same knowledge or means. They also should avoid the narrative that patients get sick because they just fail to take care of themselves properly.