New Study Shows 66% of Doctors (And Nurses) Are Racially Biased Towards Their Black Patients
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lack patients are less satisfied with care from doctors who show unintentional bias. Highly segregated areas have disparities in lung cancer death rates, research shows.
study in January’s JAMA Surgery, formerly Archives of Surgery. After accounting for smoking prevalence, income levels and other factors that could affect lung cancer mortality rates, researchers found that black patients in counties designated as highly segregated had a 26% higher lung cancer death rate — 62.9 in 100,000 — than did whites, who died at a rate of 50 in 100,000. In counties with low segregation, the death rates were virtually the same.
Two studies published in January highlight the challenges blacks face in accessing equitable, quality health care. In one study, primary care physicians found to have unconscious bias against blacks received lower marks from their African-American patients on measures of trust and communication skills. Another study found that racial segregation exacerbates disparities in lung cancer mortality. More than 130 Denver-area primary care doctors and other health professionals such as nurse practitioners took psychological tests that measure implicit bias toward different racial and ethnic groups. Test takers were shown a series of faces, along with positive words such as “joy” and bad words such as “nasty.” The speed with which the test taker associates the words with black or white faces demonstrates the existence and extent of their unconscious bias. The assessment, called the implicit association test, has been used in more than 700 studies in health care, psychology, market research and political science. About two-thirds of the Denver doctors showed implicit bias against blacks, with 43% landing unconscious bias scores graded as moderate or strong, said the study, published January in Annals of Family Medicine. Then, nearly 3,000 of all the physicians’ patients were surveyed and asked to rate the doctors on items such as knowledge of the patient, patience, caring, how well they explained things and how much they helped with decisionmaking. All of the patients, regardless of their race or ethnicity, gave their doctors generally good scores. On a 100-point scale, whites gave their doctors an average score of 82, compared with 80 for black patients.
Poverty alone does not explain the tie between segregation and lung cancer mortality, said Awori J. Hayanga, MD, MPH, the study’s lead author.
demonstrated unconscious bias on the psychological testing gave those doctors much worse ratings, nearly five points lower on average. For example, physicians who showed strong bias on the testing got a grade about six points lower on a survey about interpersonal treatment that measures perceived friendliness and respect. More than 80% of the physicians were white, and the rest were Hispanic or black. Previous studies have found that lower patient satisfaction scores are correlated with poorer outcomes on a wide range of metrics, such as medication adherence and hospital readmissions. There is still no proven way to combat the unconscious biases that can undermine some doctors’ relationships with black patients, said Irene V. Blair, PhD, lead author of the Denver study. “We’re not at that point yet where we can say, ‘Here are the five steps to be unbiased,’ ” said Blair, associate professor in the Dept. of Psychology and Neuroscience at the University of Colorado Boulder. “It’s more about how to have better patient interactions generally, thinking about how to serve the needs of individual patients, open up communication, acknowledge the perspective of the patient and develop mutual respect.”
But black patients cared for by doctors who
While Hispanic patients were the least satisfied with their care overall — grading doctors 78 out of 100, on average — there was no correlation between their physicians’ unconscious bias against Latinos and lower ratings. How unconscious bias affects physician relationships with Hispanic patients needs more study, Blair said. An Oct. 4, 2012, study in the Journal of Immigrant and Minority Health found that, surprisingly, more recent Hispanic immigrants with less English proficiency handed out higher care ratings than did more assimilated Latinos, black patients or white patients. Segregation’s lasting legacy If the persistence of unconscious bias poses a challenge for physicians struggling to connect with their minority patients, racial segregation appears to present a larger and deadlier quandary that extends well beyond the doctor’s office. Researchers reviewed lung cancer mortality between 2003 and 2007 and compared it with racial segregation patterns in 1,251 U.S. counties. Overall, blacks have a higher lung cancer death rate than whites do, with 59 in 100,000 blacks dying of the disease compared with 52 in 100,000 whites. That disparity grows wider the more segregated a community is, said a
Black Women Remain At Highest Risk For Heart Disease:
What 3 Things Can They Do?
1) Eat Healthy: Eat more fruits and vegetables. The recommended amount depends on gender and age. A 25-year-old male who does about 30 minutes of exercise per day should have a minimum of two cups of fruit and three cups of vegetables every day. The same age female should have two cups of fruit and 2.5 cups of vegetables. The requirement stays the same for a man at age 50; however, for the woman at age 50, the requirement changes to 1.5 cups fruit and 2.5 cups vegetables. A nutritional guide can be found on the Centers for Disease Control and Prevention web site.
HealthyStartt (MCJ) January, 2013
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eart disease is a major health concern in the United States. In 2008, it represented 25 percent of all deaths in the U.S. Heart disease is the cause of a third of all deaths in women. African-American women have higher rates of some risk factors for heart disease. During February, which is American Heart Month, much information is available to raise awareness of women's heart disease. Here are three key ways in which women can help lower their risk for heart disease:
2) Stop Smoking: Smoking is a major cause of heart disease for both men and women. Almost 20 percent of all deaths from heart disease in the U.S. are directly related to cigarette smoking. So, kick the habit now! 3) Exercise: Keeping the body moving through exercise is important to lowering the risk for heart disease. Exer-
cise improves many areas that are considered risk factors for heart disease.In fact, research shows that the death for heart attack patients who started and maintained a regular exercise program was reduced by up to 25 percent. Exercise lowers blood pressure, weight, stress, and
bad cholesterol but increases good cholesterol and oxygen to the body. About 30 minutes a day is all that is needed. Other important practices include regular checkups with a primary physician, controlling stress, and lowering salt intake to just 1,500 mg a day, watching out for foods loaded with salt, like pizza, snacks, processed foods, and fast food.
“It is the lack of access, the deprivation, but also the intangible sociocultural aspects of it,” said Dr. Hayanga, a heart and lung transplant fellow at the University of Pittsburgh. “One, you may not have the screening services. Two, if you do have screening services, do you have the specialists to see? Will the population dealing with this trust the system enough to go or is there a cultural barrier that stops them from going to that second phase of their care? It isn’t one thing — it’s a complex equation where enough things collude to make it happen.” The tie between segregation and lung cancer deaths “raises red flags,” said Rahn K. Bailey, MD, president of the National Medical Assn., which promotes the interests of black physicians and patients. “Unfortunately, I cannot say that it’s surprising,” said Dr. Bailey, chair of the Dept. of Psychiatry at Meharry Medical College in Nashville, Tenn. “In these segregated settings, it’s easier to channel resources in one direction and prevent them from going in another direction. Those are the types of unfortunate strategies, employed knowingly or not, that often are the culprits of disparities in health care outcomes for African-Americans.” Dr. Hayanga and his co-authors argue for broader availability of lung cancer screening and treatment in highly segregated areas. Renewed efforts to integrate residential areas could save lives, they said. --By Kevin B. O'Reilly, amednews
Lung Cancer Symptoms
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ne fourth of all people with lung cancer have no symptoms when the cancer is diagnosed. These cancers are usually identified incidentally when a chest X-ray is performed for another reason. The other three fourths of people develop some symptoms. The symptoms are due to direct effects of the primary tumor; to effects of cancer spread to other parts of the body (metastases); or to disturbances of hormones, blood, or other systems. Symptoms of lung cancer include cough, coughing up blood or rusty-colored phlegm, fatigue, unexplained weight loss, recurrent respiratory infections, hoarseness, new wheezing, and shortness of breath. 9 A new cough in a smoker or a former smoker should raise concern for lung cancer. 9 A cough that does not go away or gets worse over time should be evaluated by a health care provider. 9 Coughing up blood (hemoptysis) occurs in a significant number of people who have lung cancer. Any amount of coughed-up blood should be evaluated by a health care provider. 9 Pain in the chest area is a symptom in about one fourth of people with lung cancer. The pain
is dull, aching, and persistent. 9 Shortness of breath usually results from a blockage in part of the lung, collection of fluid around the lung (pleural effusion), or the spread of tumor through the lungs. 9 Wheezing or hoarseness may signal blockage or inflammation in the lungs that may go along with cancer. 9 Repeated respiratory infections, such as bronchitis or pneumonia, can be a sign of lung cancer. Symptoms of metastatic cancer depend on the extent and location of the cancer spread. About 3040% of people with lung cancer have some symptoms or signs of metastatic disease. 9 Lung cancer most often spreads to the liver, the bones, and the brain. 9 Metastatic lung cancer in the liver may cause yellowing of the skin and eyes (jaundice) but it may not cause any noticeable symptoms at the time of diagnosis. 9 Lung cancer that has metastasized to the bone causes bone pain, usually in the bones of the spine (vertebrae), the thigh bones, and the ribs. 9 Lung cancer that spreads to the brain can cause difficulties with vision, weakness on one side
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