Medical schools are placing an increased emphasis on diversity and inclusion, and efforts appear to be (slowly) paying off. Recent initiatives have led to an increase in U.S. enrollees reporting a disability, and a new textbook is attempting to close the knowledge gap surrounding LGBTQ health issues.
But — as we’ve said many times before — “diversity” and “inclusion” don’t go hand-in-hand. Creating an inclusive space for student doctors is commendable, but such initiatives are useless if institutional bias results in failures to promote and retain those physicians once they enter the workforce.
Another concern, and one that medical colleges have little control over, is patient bias. It’s a problem because doctors who have faced discrimination report higher levels of burnout and are more likely to leave their job.
In light of this, a team from Yale University and the University of Michigan set out to determine the prevalence of patient-led discrimination.
In the study, which has been published in JAMA Network Open, researchers took a randomized sample of 3,592 online responses and provided participants with a fictional scenario.
Volunteers were told to imagine a visit to the ER for stomach symptoms. At the hospital, they received tests, a diagnosis, and a treatment plan from a simulated physician.
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Alongside the physician diagnosis, they were given a contradictory diagnosis from an online symptom checker, which was intended to cast doubt on the doctor’s assessment.
Every volunteer was provided with a photograph of their doctor. In total, 823 participants were assigned to black female physicians, 791 to black men, 828 to white women, and 835 to a “control” group of white men.
Good news — with ‘a grain of salt’
Researchers found patients rated their satisfaction with their simulated ER visit the same, regardless of the doctor’s race or gender. Confidence in the physician didn’t appear to vary, either.
This appeared to be true even when the authors accounted for the demographic characteristics of the respondents.
While the findings aren’t meant to suggest doctors won’t face bias, lead author Rachel Solnick, M.D., M.Sc. says she was surprised with the results — given it was her own experiences with workplace discrimination that inspired the study.
“We were really surprised that even after looking at these data in many different ways, we did not see evidence of racial or gender bias affecting patient satisfaction or confidence,” Dr. Solnick said in a statement.
“This is not to say that people are bias-free, but it did not appear to enter into their ratings of care in surveys. This is good news, with a grain of salt.”
While the study accounts for diversity in terms of black and white, male and female, the findings are limited.
It does not, for example, look into how other minority doctors are treated.
This additional information could be insightful because previous research suggests doctors from other ethnic and racial backgrounds, doctors with disabilities, non-binary, non-native English speakers, and younger (or younger-looking) doctors may be more likely to experience workplace discrimination.
Solnick and her colleagues note that bias can also come from within an organization and say their research warrants additional examination into other potential sources of workplace toxicity, including discrimination from peers and superiors, as well as restrictive policies that force some minority doctors from their field.