Is there a racial ‘care gap’ in medical treatment?

A new survey has found implicit biases in medical students that may explain why black patients are sometimes undertreated for pain, with some students believing that black people feel less pain and have thicker skin than white people. For more on the perplexing discovery, Gwen Ifill talks to Dr. David Satin of the University of Minnesota and Dorothy Roberts of the University of Pennsylvania.

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    A new study finds African-American patients are often treated differently when it comes to medicine and care. The survey of more than 500 people, 400 of them medical students, found implicit bias exists that may help explain why black people are sometimes undertreated for pain.

  • Among its findings:

    Medical students believed that African-Americans felt less pain than white patients, and even thought their skin was thicker.

    For more on this perplexing discovery, we turn to Dr. David Satin of the University of Minnesota Medical Center, and Dorothy Roberts of the university of Pennsylvania.

    Thank you both for joining us.

    Dr. Satin, try to describe this disparity for me. Why does this exist? And is it new?

    DR. DAVID SATIN, University of Minnesota Medical Center: So, Gwen, we have known that this has been an issue for at least a couple decades.

    And every now and then, a study comes out that underscores the need for the field of medicine, and in particular medical education, to do some work and get it right.

    So, this is a problem, and it's been a problem, and hopefully this study will spur on more activity.


    Dorothy Roberts, is this a medical problem or a sociological problem?

    DOROTHY ROBERTS, University of Pennsylvania: It's both.

    I think what's really important and fascinating about the study is that it, for the first time, links what we have long known as undertreatment of pain for black patients with doctors, or at least medical students' false beliefs about biological differences based on race.

    And those beliefs, as the study has shown, are widely held by laypeople as well. They're deeply embedded, longstanding myths about racial difference, especially biological differences between races, which goes back to the very concept that race is a biological difference that is widespread in U.S. society. So it's sociological, as well as medical.


    Dr. Satin, I have to say the thing that surprised me the most was that medical students would think this way, as well as laypeople.

    So, are they being taught this? Is this something they just bring with them?


    Unfortunately, it's both.

    So, medical students, doctors are people, too. We live in society, and we're exposed to the same decade-after-decade experiences that determine our beliefs. However, one of the things one of the medical student pointed out to me this morning is that some of these false beliefs seem to peak in second year — the second year of medical school, as students prepare for the boards and have been memorizing these associations to answer on the board exams.


    This is a taught behavior or action. This is a conscious stereotype, as well as a subconscious one.



    It's deeply rooted and fundamental to the way medical education works in the United States. Students are taught to notice the race of their patients, to treat their patients differently because of race, and they're taught that that's because of fundamental biological differences between people of different races.

    So, while this is in part based on myths and stereotypes that are widely held in U.S. society, it's also based on the way students are taught to treat patients in medical schools. It requires a radical change in medical education to address this, not only addressing implicit bias, but also changing the way in which human beings are treated and differences are considered in medical education.


    David Satin, there are actually, to be fair, race, not specific, exactly, conditions, but medicines and conditions which are more likely to affect one race or the other.


    Those are controversial. We know that race is actually a socially constructed concept. It's not biological, nor is it genetic, as we learned from the Human Genome Project.

    And so while there are some associations, those are largely due to social effects, how we're raised. Often, ethnicity plays a factor. But they are not biological effects.


    But environmental effects, perhaps?


    Well, I think that's really important for medical students to understand and for their teachers to teach them is the difference between health outcomes, disparate health outcomes, and the idea that they're caused by innate biological difference, which is false, vs. how racism does affect health based on social inequality, not because of innate biological or genetic differences between the races.

    And this study points out how dangerous it is to continue to teach medical students that race is a biological category that produces these differences in health or experience of pain based on biological differences between the races.


    Well, let me ask you both, this wasn't a huge study.

    This is 400, 500 people, but what is your thinking — I will start with you, David Satin — on what the consequences are of these beliefs and what should be done about it?


    So, the consequences of the beliefs, we saw in the study, is part of what results in unequal treatment. It's part of what results in health disparities.

    There's certainly enough blame to go around for how those result, but it's a component. And what it teaches us is that we need to be proactive. I teach the medical students, look, it's not your — it's not your fault that you have these implicit biases. You grew up in society. We all have these.

    But now that you know, it's your responsibility. And we have some interventions to try to reverse that.


    But it also requires a fundamental change in the way in which medical education works, moving away from teaching students that the races are different because of some kind of innate biological difference that then causes health disparities, and instead showing how racism and other structural inequities cause health disparities, and explore with students how medical practice can address those.


    Dorothy Roberts of the University of Pennsylvania, and Dr. David Satin of the University of Minnesota Medical Center, thank you very much.


    Thanks, Gwen.


    Thank you for having me.

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