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Implicit Bias on the Deathbed: Study Shows Doctors Show Less Compassion, Empathy, Communication for Dying Black Patients

2015 UPMC

2015 University of Pittsburgh Medical Center

A new study points to racial discrimination in the health profession, this time by doctors against dying Black patients. This is yet more evidence that white supremacy is an enduring proposition, following us from the womb to the tomb.

The January issue of the Journal of Pain and Symptom Management sets the stage for us.  The study found that when Black actors portrayed hospital patients on their deathbed, the doctors provided them with less compassionate care than white patients.  The authors of the study set out to test whether physicians in the hospital use different verbal and non-verbal communication depending on the race of their patients.

The results, using 33 doctors from Western Pennsylvania, were sobering: Doctors had 7 percent less interaction with Black patients than with white ones.  With dying white patients, doctors tended to stand closer to the patient and touch the patient in a caring manner.  However, with Black patients nearing “death” in this simulated exercise, doctors tended to maintain a distance—both physically and emotionally—standing near the door, making less eye contact, with arms folded or holding a chart.  Through this non-verbal communication, these white physicians displayed less empathy, encouragement, warmth, respect and understanding towards Black patients, reflecting the behaviors Black people face from whites in everyday life.

Looming in the context of this research is the role of implicit bias in society, which includes the “attitudes or stereotypes that affect our understanding, actions, and decisions unconsciously,” the authors note. In a non-medical setting, Blacks experience this implicit bias through non-verbal communication.  Meanwhile, in a hospital setting, Black patients are more likely than their white counterparts to die in the intensive care unit, with life support, feeding tubes and other aggressive treatments to prolong their life, even as most people prefer to spend their final days in hospice care rather than in a hospital.  Further, Black people are less likely to receive preventative treatments and early cures.  Chalk it up to implicit bias, the study suggests:

Race has been shown to play a role in nonverbal communication between primary care doctors and geriatric patients in the ambulatory setting. It has been speculated that a physician’s inability to recognize a minority patient’s nonverbal cues and the physician’s disengaged nonverbal communication when working with minority patients leads to greater patient dissatisfaction, worse patient compliance, and may contribute to racial disparities in patients’ health outcomes.

“When black and white patients receive more intensive treatment at the end of life than they prefer—for example in the ICU—it may result in various types of ‘suffering’—including post-traumatic stress disorder among the bereaved family members,” said Dr. Amber E. Barnato, associate professor at the University of Pittsburgh School of Medicine and senior author of the study, to The Huffington Post.  Barnato cited greater compassion and self-awareness among doctors, and the national discussion on racism as possible ways to help alleviate these differences.

This is not the only study pointing to race-based disparities in treatment.  For example, research published last year found that Black, Brown, less-educated and unemployed people waited 25 percent longer to see a healthcare professional. Meanwhile, studies have shown that race-based trauma is a reality for Black people, with exposure to racism and violence causing PTSD, or post-traumatic stress disorder.

Even children of color are not immune from medical racism. According to a study from JAMA Pediatrics on the pain management of children in hospital emergency departments, Black and Latino children being treated for acute appendicitis were less likely to receive painkillers than white children.

However, on a positive note, another study from the U.S. Department of Veterans Affairs concluded that Blacks live longer than whites when racial disparities in medical care are eliminated.

Implicit bias can kill Black people, and chase them to their grave. Eradicating the disease of racism is the key to improving the way in which Black people live and die.

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