7 Racism in Medical Education and Medicine
In Part 1, we examined how race has been used to create hierarchies and uphold discriminatory practices. Beliefs that correlate biological characteristics with race have been ingrained in medical education, leading to the victimization of people of color within the healthcare system. Implicit biases among U.S. physicians, favoring White Americans over Black Americans, combined with medical teachings that link race and disease without proper context, further perpetuate stigma and mistreatment of racial minorities. We explore this in more detail below.
Racism and Health
Health Affairs Feature: Racism & Health In US Medicine
A Conversation with Harriet A. Washington
Medical Education
A 2016 study reported that medical students and residents held “false and fantastical” beliefs about biological differences between Black and White people, which resulted in a racial bias in pain perception. These biases led to inadequate treatment recommendations for Black patients experiencing pain.[1]
Despite overwhelming evidence linking societal inequities to poor health outcomes, medical education in the United States fails to adequately teach students that health disparities are manifestations of structural racism, which disproportionately impact racial minorities. Providing this context is critical to a true understanding of health inequities and why they persist more frequently in communities of color. Instead, race is often misrepresented in medical school curricula, resulting in race-based bias and the pathologizing of race. Oversimplifying the connection between race and disease falsely asserts that race alone determines disease risk and reinforces the misconception that health disparities are caused by inherent racial differences. This perspective disregards the role of social determinants of health as causal factors in the development of health disparities. As a result, opportunities for medical students to examine the relationship between race, racism, and health outcomes are lost, perpetuating false narratives and contributing to the ongoing cycle of inequity and poor health outcomes.
Amutah described a lecture that presented “race-and ethnicity–adjusted life expectancy” without explaining how race or ethnicity affects life expectancy. Without additional context, students are left to assume that life expectancy and race are directly correlated.[2]
Physician Max Romano reflects on how racial privilege influenced his medical training in “White Privilege in a White Coat: How Racism Shaped My Medical Education.” In his essay, Romano asserts that although physicians are becoming more aware of how the social determinants of health contribute to health disparities, White physicians seldom examine how their “racial privilege reinforces a White supremacist culture and what effects this may have on our patients’ health.”
Romano describes an incident that occurred after a young Black male patient died from multiple gunshot wounds. Residents and staff involved in cleaning up after his death laughed at a joke made by one of the residents, which implied that the deceased young man was “immediately implicated as a criminal drug dealer based on his age, race, gender, manner of death, and the contents of his pockets, all substantiated by the house staff’s expertise in television crime dramas.”
Stereotypes, racial tropes, and the miseducation of future physicians based on racist beliefs are not humorous. They are harmful and deadly.
A 2023 survey by the Kaiser Family Foundation documented the extent and effects of racism and discrimination in people’s interactions with the healthcare system. This national survey, which gathered responses from more than 6,000 adults, offered new insights into individuals’ experiences with racism and discrimination, highlighting the impacts both across the general population and within specific racial and ethnic groups. The study revealed that many Hispanic, Black, Asian, American Indian, and Alaska Native adults in the United States believe they must modify both their mindset and their appearance to avoid potential mistreatment during healthcare visits. Specifically, the study found that six in ten (60%) Black adults, about half of American Indian and Alaska Native adults (52%) and Hispanic adults (51%), and four in ten (42%) Asian adults said they prepare for possible insults from providers or staff and/or feel they must be very careful about their appearance to be treated fairly during healthcare visits at least some of the time. In addition, one-third of White adults reported doing the same.
Numerous studies have examined the differential treatment of Black patients by their healthcare providers. Black patients are more likely than White patients to experience negative interactions with individuals in the healthcare system. These negative interactions result in less effective patient-provider communication, poorer health outcomes, and significant health disparities among people of color.
Negative Interactions Experienced by Patients of Color During Medical Encounters
- Providers assuming something about them without having asked
- Experiencing microaggressions
- Suggesting the patient was personally to blame for their health problem
- Ignoring direct questions
- Harsh communications
- Refusing pain medication
Nearly a quarter of black adult patients, 19% of American Indian and Alaska Native adults, 15% of Hispanic adults, and 11% of Asian adults experienced at least one of these and implicated race as a contributing factor. Only 4% of white adults had similar experiences.[3]
In 2020 Physician Janice Sabin assessed how medical trainees’ false notions and biases contribute to inadequate treatment of pain among minority patients. In her piece, she cites a meta-analysis with 20 years of cumulative data that found that black patients were 22% less likely than White patients to receive pain medications. Sabin also cites a study by Hoffman that provided evidence that White laypeople, medical students, and residents believe the Black body is biologically different than the White body. These beliefs are associated with racial bias in perceptions of others’ pain, which in turn influences the accuracy of pain treatment recommendations. Hoffman concludes that false beliefs about biological differences between Black and White people continue to shape the way Black patients are treated, and that these beliefs are associated with racial disparities in pain assessment and treatment recommendations.
Sabin states that disparities in treatment are not always intentional but often the result of unconscious biases among providers. She suggests that healthcare providers engage in self-reflection to uncover any biases that could lead to differential treatment, so they can deliver equitable care to all patients regardless of race. She also asserts that educators who train future physicians must ensure that racist misinformation is actively dispelled.
Read more of Sabin’s article here: How we fail black patients in pain
In 2020, as the nation’s largest professional association of physicians, the American Medical Association (AMA) acknowledged its long history of discriminatory practices against Black physicians and its role in reinforcing systems of inequity that harmed patients of color. In the wake of the death of George Floyd, an unarmed Black man killed by a White police officer in May 2020, and amid the COVID-19 pandemic, which led to the deaths of Black people at rates far exceeding those of White people, the organization issued the following press release on June 7, 2020:
At a virtual Special Meeting of the American Medical Association (AMA) House of Delegates, the AMA Board of Trustees pledged action to confront systemic racism and police brutality, and released the following statement:
- The AMA recognizes that racism in its systemic, structural, institutional, and interpersonal forms is an urgent threat to public health and the advancement of health equity and a barrier to excellence in the delivery of medical care.
- The AMA opposes all forms of racism.
- The AMA denounces police brutality and all forms of racially motivated violence.
- The AMA will actively work to dismantle racist and discriminatory policies and practices across all of health care.
The American Medical Association (AMA) officially declared racism a public health crisis on November 16, 2020. In this declaration, the AMA recognized the significant role racism plays in perpetuating health inequities, leading to worse health outcomes for marginalized communities. The statement was part of a broader effort to address systemic inequities and advocate for antiracist policies in the healthcare system.
The AMA then developed its first strategic health equity plan, dedicated to embedding racial justice and advancing health equity.
References:
- African American experiences in healthcare: I always feel like I’m getting skipped over
- The Associations of Clinicians’ Implicit Attitudes About Race With Medical Visit Communication and Patient Ratings of Interpersonal Care
- Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients
- A Prospective Examination of Racial Microaggressions in the Medical Encounter
- Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study
- Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review
- Racial bias in pain assessment and treatment recommendations ↵
- Misrepresenting Race -- The Role of Medical Schools in Propagating Physician Bias ↵
- https://www.kff.org/racial-equity-and-health-policy/press-release/new-kff-survey-documents-the-extent-and-impact-of-racism-and-discrimination-across-several-facets-of-american-life-including-health-care/ ↵
