Tuesday, October 20, 2020

Racism & Medical Care

It is an article of faith that health care providers are racially discriminatory.  This is curious to me, because in my experience, doctors are at the far end of political spectrum on the left.  So I tried to find research on race and medical care.   Overwhelmingly,  I found papers about perceived racism by patients.  Now,  perceived racism could be real racist treatment.  Or it could be that because blacks tend to mistrust doctors,  they perceive racism that is not there.  The reasons for this are easy to understand.   The Tuskegee Syphilis Study is one of the morally low points of American medical science.  It started with a legitimate scientific question: "does syphilis affect blacks differently than whites?" It soon failed to be relevant once penicillin was available to cure syphilis.  Moving members of the control group (no syphilis) to the study group (those with syphilis at start of study) destroyed the scientific value.   CDC doctors directing outside doctors to not treat study group members once penicillin was available was a heartless and monstrous act,  leading to subsequent blindness,  madness, death, and crippling in the tertiary stages.  The Immortal Life of Henrietta Lacks also had long provided legitimate concern about the medical profession.  Cancer cells from Mrs. Lacks eventually led to very profitable medicines, with no benefit to her heirs 

When I tried to find studies that actually measured racism by healthcare providers,  I found darn near nothing.  This is unsurprising.  How do you measure racism? A survey is not going to get very straight answers except at the Stormfront Medical Center. 

One study pointed to a problem of confounding variables:

  One-hundred-forty-five African-American subjects participated in structured interviews to collect demographic and psychosocial data. Provider data was obtained through chart audits. In a group of low-income African Americans in two primary care clinics, perceptions of racism and mistrust of whites had a significant negative effect on trust and satisfaction. Perceived racism had both a significant, inverse direct effect on satisfaction as well as a significant indirect effect on satisfaction mediated by cultural mistrust and trust in provider. Structural equation modeling analysis supported the hypothesized theoretical relationships and explained 27% of the variance in satisfaction with care.

So patients who had mistrust problems were more likely to see racism as a problem?  Is this a surprise to anyone?  Long-term mistrust of white doctors (and not entirely without cause) will lead to perceived racism and dissatisfaction with medical care. 

This paper observes that along with institutional racism and  personal provider racism:

Finally, Jones defines internalized racism as the acceptance by members of stigmatized races of negative messages about their abilities and intrinsic worth (Jones, 2000). Internalized racism can have many manifestations, including helplessness, self-devaluation, and limiting one’s right to self-determination and self-expression (Jones, 2000). Our participants reported a decreased ability of African-Americans to question their treatment and speak up to their physicians, and also described devaluing characteristics (e.g. poor physical presentation, not “speaking well”) as potential causes of communication disparities.

While there is no consensus on how to best measure healthcare discrimination (Kressin, Raymond, & Manze, 2008), most researchers rely upon patient reports of perceived discrimination--a strategy with inherent advantages and disadvantages. While perceptions may be misinterpreted, they do reflect patients’ personal experiences and how they are internalized, which may be important to how discrimination affects health (see discussion below). This may be particularly true for patients who lived through U.S. segregation, as their historical healthcare experiences undoubtedly shaped how they currently experience healthcare encounters. In our study, all but three participants were born before the 1964 Civil Rights Act outlawing U.S. segregation.

1 comment:

  1. I seem to remember a "Reason" article about the experiments in which part of the reasoning was that penicillin was not effective after a certain period of time which had already passed before penicillin was discovered.