Although providers might like to believe that they do not harbor unconscious biases, research shows that they are just as likely as others to do so. A 2019 study that asked subjects to identify pain expressed in photos found that white participants more readily recognized pain on white faces than on black faces. In addition, in-group bias - identifying more with one’s own group - also influences providers’ ability to assess pain. Providers are not immune to stereotypes and images frequently portrayed in the media, which tend to associate African Americans with substance abuse. … Instead, inequities are the product of complex influences, including implicit biases that providers don’t even know they have. Racial and ethnic disparities in pain treatment are not intentional. In fact, in the meta-analysis, the greatest racial disparity in pain treatment was for conditions like backache, migraine, and abdominal pain. Additionally, in cases of medical ambiguity - as when pain isn’t caused by an obvious physical condition such as traumatic injury - providers rely more heavily on their own judgment, which can be influenced by personal perceptions and biases. In addition, assessment of pain is inherently subjective. People process pain differently and can express it in ways that are silent or loud, articulate or guttural, demonstrative or reserved. What spurs pain treatment disparities?Īssessment and treatment of pain are complicated. ![]() Health care providers must prioritize the need to better assess and treat pain equally in all people, and educators who influence tomorrow’s physicians must ensure that any racist misinformation is dispelled. Inadequate treatment of pain because of a patient’s race, ethnicity, gender - or any other characteristic - is simply unacceptable. So far, more than 1,000 faculty members in our five-state region have enrolled, and ongoing research shows that awareness of personal, medical, and societal implicit bias significantly increases following the course.ĭespite advances, much work remains. At the University of Washington School of Medicine where I work, for example, we created an online course for faculty called Implicit Bias in the Clinical and Learning Environment in 2017. In recent years, academic medicine has made impressive strides in focusing on health care inequities, and many medical schools now make sure to teach about implicit bias. Instead, inequities are the product of complex influences, including implicit biases that care providers don’t even know they have. ![]() Racial and ethnic disparities in pain treatment are not intentional misdeeds: health care providers do not decide that some groups deserve pain relief while others should suffer. ![]() What’s more, a meta-analysis of 20 years of studies covering many sources of pain in numerous settings found that black/African American patients were 22% less likely than white patients to receive any pain medication. In a 2012 study, my colleagues and I found a correlation between pediatricians’ implicit (unconscious) racial biases and how they treated pain in a simulated African-American or white teenager following surgery: As the strength of provider implicit bias favoring whites increased, the likelihood of prescribing appropriate pain medication decreased only for the black patient. I find it shocking that 40% of first- and second-year medical students endorsed the belief that “black people’s skin is thicker than white people’s.” In the 2016 study, for example, trainees who believed that black people are not as sensitive to pain as white people were less likely to treat black people’s pain appropriately. ![]() What’s more, false ideas about black peoples’ experience of pain can lead to worrisome treatment disparities. In fact, half of trainees surveyed held one or more such false beliefs, according to a study published in the Proceedings of the National Academies of Science. They are notions harbored by far too many medical students and residents as recently as 2016. These disturbing beliefs are not long-forgotten 19th-century relics. “Black people’s nerve endings are less sensitive than white people’s.” “Black people’s skin is thicker than white people’s.” “Black people’s blood coagulates more quickly than white people’s.” Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.
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