Implicit Racial Bias in the Diagnosis & Treatment of Black Patients with COVID-19
Updated: Aug 29, 2020
By: Helena Zeleke
(Retrieved from CNN (Originally from Atlanta-Journal Constitution/AP); Taken by Curtis Compton)
The Problem
Reginald Relf, a Black engineer with diabetes, died in his basement weeks after being denied medical treatment by a Chicago Urgent Care Clinic for his worsening COVID-19 symptoms. His family questions whether the hospital’s response would have been different if their beloved family member belonged to a different race. Would a White patient have been subject to the same cold shoulder from the medical community?
Deborah Gatewood, a Black phlebotomist for Beaumont Health, was repeatedly turned away by her own hospital after presenting COVID-19 symptoms and her requests for testing fell on deaf ears. Not until she reached the point of near-death was she transported by ambulance to a nearby hospital, where she tested positive for COVID-19 and died shortly thereafter.
Twice, Rana Zoe Mugin, a Black educator and activist, went to Brookdale Hospital in Brooklyn, New York, with COVID-19 symptoms and was denied testing both times. Her sister recounts an EMT dismissing Ms. Mugin’s symptoms as a “panic attack.” Rana Zoe Mugin died from COVID-19 in late April.
Reginald Relf, Deborah Gatewood, Rana Zoe Mugin, and several others have had their stories swept under the rug and dismissed as hospital politics—maybe there weren’t enough tests? Not enough hospital beds?
However, research on implicit racial bias, which is defined as the tendency for people to subconsciously attribute stereotypes to certain racial groups, indicates that there may be more to the story.
The Consequences of Implicit Racial Biases
A 2015 systematic review of the literature on implicit racial bias in healthcare facilities reported that “Black patients perceived poorer treatment in domains such as patient centeredness, contextual knowledge of the patient, and patient-provider communication from providers who demonstrated implicit bias against Blacks on the IAT (Implicit Association Test)” (Hall et al., 2015). Data from the National Healthcare Disparities Report and countless other research teams also echo this finding, proving that healthcare workers are no different than any other cohort of professionals in that they, too, take their conditioning and biases with them into the workplace. However, what healthcare workers choose to do with their implicit biases can have life-or-death consequences for their "clients." Therefore, it is imperative that these biases are mitigated and consistently challenged by those around them.
Due to the current COVID-19 pandemic, healthcare providers are under more pressure than ever to quickly shuffle through patient interactions in order to minimize face-to-face contact. Thus, it’s no surprise that implicit racial bias has reared its ugly head amidst this worsening global crisis. Although we don’t yet have data on the extent to which implicit racial bias has contributed to the disproportionate impact of COVID-19 on Black communities, the lived experiences of patients like Reginald Relf, as well as the long-standing history of tense relations between the Black community and medicine, suggest that implicit racial biases pose a very real threat to the livelihood of Black patients. We shouldn’t have to wait for these patients to turn into statistics for us to open our ears and listen to their concerns.
The Solution
The Centers for Disease Control and Prevention (CDC) released a statement earlier this year urging healthcare providers to be cautious of the way their subconscious assumptions guide their medical decisions. However, the public’s apparent apathy towards similar calls to action in the past by physicians, Black patients, and their loved ones indicates that a more targeted approach is necessary to herald tangible change in the medical field.
Implicit racial bias is just that: implicit, meaning it isn’t plainly expressed in our actions or beliefs. It manifests itself in the decision-making processes of physicians and entire institutions in ways that can be more insidious than blatant discrimination. Unfortunately, this also makes implicit bias harder to call out and identify in other people and within ourselves, and also makes for a problem that can’t be fixed with an ideological shift, grand epiphany, or PR statement.
Implicit racial bias can be found in a condescending tone of voice or through the downplaying of a patient’s painful experience. Physicians who engage in these types of behaviors may have politically correct and anti-racist explicit biases, which would show in their agreement and support for statements like the one put out by the CDC. However, under the stress of the hospital environment and without feedback from patients and co-workers, their implicit biases may unfortunately take center stage.
Thankfully, though, implicit racial biases are just as “malleable” as they are unconscious (Kirwan Institute for the Study of Race and Ethnicity, 2015). According to Linda Tropp and Rachel Godsil of the The Society for the Psychological Study of Social Issues, we can work to “de-bias” ourselves by engaging in consistent and intentional efforts to identify situations where our values don’t align with our decisions. These efforts can take the form of a variety of different interventions, including practices like perspective-taking and inter-group contact. Social scientists and psychologists have done the work to identify the best practices for healthcare-specific interventions targeting implicit racial bias, but their efforts are largely useless if hospital systems and the medical education system don’t prioritize their application.
We can also work against implicit racial bias by making the medical field more representative of the population it serves. By increasing the number of Black healthcare workers, we can ensure that these patients have people involved in their care who are less blindsided by their conditioning. Additionally, Black patients may also feel more comfortable communicating their concerns with Black physicians because they are less associated with the medical maltreatment historically spearheaded by predominantly White institutions. But again, healthcare systems won’t prioritize diversity unless they’ve identified that implicit racial bias actively poses a threat to the quality of patient care.
Thus, this brings us back to the importance of patient testimonies: Each one is a call to action. Each life lost has the potential to be a resounding alarm to those in power, but only if the sound is amplified by members of the public. By elevating the stories of those brave enough to speak on how they were wronged, we can make a small but essential step in the right direction.
Regardless of whether or not you are a healthcare provider, there are several resources available on our website, Instagram, and Facebook pages for you to use to actively work against implicit racial bias. Take a stand and stay willing to unlearn things you never thought you knew — The safety and well-being of entire communities depend on it.
References:
Abdullah, K. (2020, May 8). IMPLICIT BIAS A DRIVER OF COVID-19 AMONG AFRICAN AMERICANS. Retrieved from https://ethnicmediaservices.org/covid-19/implicit-bias-a-driver-of-covid-19-among-african-americans/
BerthaCoombs. (2020, June 22). Black doctors push for anti-bias training in medicine to combat health inequality. Retrieved from https://www.cnbc.com/2020/06/19/black-doctors-prescription-for-changing-racial-inequity-in-health-care.html
Eligon, J., & Audra. (2020, May 10). Questions of Bias in Covid-19 Treatment Add to the Mourning for Black Families. Retrieved from https://www.nytimes.com/2020/05/10/us/coronavirus-african-americans-bias.html
Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., . . . Coyne-Beasley, T. (2015). Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American Journal of Public Health, 105(12). doi:10.2105/ajph.2015.302903
Kirwan Institute for the Study of Race and Ethnicity. (2015). Understanding Implicit Bias. Retrieved from http://kirwaninstitute.osu.edu/research/understanding-implicit-bias/
Mitropoulos, A., & Moseley, M. (2020, April 28). Beloved Brooklyn teacher, 30, dies of coronavirus after she was twice denied a COVID-19 test. Retrieved from https://abcnews.go.com/Health/beloved-brooklyn-teacher-30-dies-coronavirus-denied-covid/story?id=70376445
Tropp, L. R., & Godsil, R. D. (2015, January 23). Overcoming Implicit Bias and Racial Anxiety. Retrieved from https://www.psychologytoday.com/us/blog/sound-science-sound-policy/201501/overcoming-implicit-bias-and-racial-anxiety