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Race, Class Biases Exist But Don’t Affect Trauma, Acute-Care

BOSTON – How do unconscious race and social class biases affect care provided by trauma and acute-care clinicians?

While those biases exist, according to a report published online recently by JAMA Surgery, they don’t appear to have much effect on clinical decisions.

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Background information in the study, led by researchers from Brigham and Women’s Hospital in Boston, notes that disparities in the quality of care received by minority patients have been reported for decades across multiple conditions, types of care and institutions.

To determine how that affected care, the study conducted a web-based survey among doctors from surgery and related specialties at an academic, level I trauma center.

Using the Implicit Association Test (IAT) for race and class to measure the strength of a person's automatic associations, unconscious attitudes were assessed according to the speed with which respondents pressed computer keys as a way to gauge the ease with which respondents sorted out mental concepts. The study included four race vignettes and four social class vignettes involving patients who were white and black and those of upper and lower social classes.

With 215 clinicians participating – 74 attending surgeons, 32 fellows, 86 residents, 19 interns and four physicians – the study uncovered implicit race and social class biases for most respondents. Average test scores among all clinicians were 0.42 for race, indicating moderate preference, and 0.71 for social class, indicating strong preference. Practitioner specialty, race or age did not appear significant in terms of the results, nor did subtle differences in scores between women and men after further analyses, according to the report.

Some analyses showed possible associations between race and social class biases among participants in three of 27 patient management options in the survey vignettes –respondents being more likely to diagnose a young black woman with pelvic inflammatory disease rather than appendicitis and being less likely to order an MRI of the cervical spine for patients with neck tenderness after a motor vehicle accident if they were of low rather than high socioeconomic status. Those differences were not significant in further analysis.

The study overall found no differential patient treatment related to race or social class biases, according to the authors.

"Although this study of clinicians from surgical and other related specialties did not demonstrate any association between implicit race or social class bias and clinical decision making, existing biases might influence the quality of care received by minority patients and those of lower socioeconomic status in real-life clinical encounters,” the study concludes. “Further research incorporating patient outcomes and data from actual clinical interactions is warranted to clarify the effect of clinician implicit bias on the provision of health care and outcomes.”