Stereotypical attitudes lead to health inequities

Dr. Michele van Ryn from University of Minnesota Medical School, Minneapolis, and colleagues evaluated the factors associated with whether or not doctors recommended coronary artery bypass graft surgery (CABG) for heart patients. Among 532 patients, who were all appropriate candidates for this procedure, 34 percent were white, 30 percent were black and 36 percent were Hispanic.

Only 21 percent of black men were recommended for CABG, the investigators report, compared with 40 percent of white and Hispanic men. There were no differences in treatment based on race or ethnicity among women, according to a report to be published in the February issue of American Journal of Public Health.

Black patients were significantly younger than whites, the team found. White patients were significantly less likely than black patients to have Medicaid or no insurance coverage, at 3 percent and 21 percent, respectively.

Overall, physicians were significantly less likely to rate blacks as likely to comply with medical advice, to have significant career demands, have social support and have a physically active lifestyle.

Physicians' recommendation for CABG was significantly associated with their perception that the patient wanted a physically active lifestyle and was educated, the researchers note.

It is possible for doctors to become aware of their biases and to change them, Dr. van Ryn told Reuters Health.

"I think it might be worthwhile for providers to try to self-monitor and then treat these unconscious beliefs as hypotheses to be tested in the clinical encounter," van Ryn said. "For example, if a cardiologist monitored herself and became aware that she had concerns about whether a patient would engage in high-risk behaviors or wouldn't participate in cardiac rehab...that could be a cue to explore these matters with the patient."

However, "we know little about the individual characteristics that make the physician more or less susceptible to unconscious bias," van Ryn added. "To develop effective interventions, we need to know a lot more about the factors that mediate and moderate this effect."

SOURCE: American Journal of Public Health, February 2006.