IB 110 Chap.8 Racial Bias in Diagnosis and Treatment
Racial Bias in Diagnosis and Treatment
Three sources of bias
The fourth lecture names three sources of bias in healthcare: bias in how doctors are trained, implicit bias, and bias in research studies.
Each can turn into a difference in diagnosis or outcomes that is then recorded as if it were a difference between racial groups.
Training and diagnosis on darker skin
The third lecture shows a web image search for skin rashes, prompting the question of which skin tones such reference pictures show.
It cites a UCSF report that nearly half of surveyed US dermatologists felt their training had not prepared them to diagnose disease on Black or brown skin.
It then cites a 2022 study of Lyme disease: about one in three Black patients newly diagnosed already had neurological complications such as meningitis or neuropathy, compared with fewer than one in ten White patients, suggesting that earlier signs were missed.
Implicit bias
Implicit bias is defined as stereotypes or prejudices about a group that a person holds without being aware of them.
The lecture's examples are the model-minority stereotype of Asian Americans and the false belief that Black people feel less pain.
A 2015 systematic review found low to moderate implicit bias among health professionals in all but one study, and linked it to how clinicians and patients interact, which treatments are chosen, adherence and outcomes, though not every association was significant.
Cultural sensitivity
Bias also affects whether people seek care.
A 2014 magazine article used in the lecture describes barriers many Latino patients face, including language, a cultural emphasis on trust, respect for traditional medicine and diversity within the Latinx community, and argues that rushed visits can feel untrustworthy to patients who expect a personal relationship.
The vitamin D case
Vitamin D deficiency is linked to many chronic diseases.
The lecture shows research in which the probability of deficiency differed by body weight and was highest for non-Hispanic Black adults, and a 2013 study of 12,505 survey participants that found that socioeconomic factors did the most to drive skin-colour based health disparities, while noting that vitamin D differences may also need to be addressed.
A lecture question asks how this differs from race causing disease; the answer is that it names a measurable mechanism tied to pigmentation.
How to use this chapter in an answer
When a question gives you a racial gap in diagnosis or treatment, locate the step where it arises before offering any biological account.
Training decides what a clinician can recognise, judgement decides how symptoms are weighed, research decides what the textbook says, and trust decides whether the patient comes back.
What this chapter covers
- 01
Three sources of healthcare bias
- 02
Training gaps on darker skin
- 03
Late Lyme disease diagnosis
- 04
Implicit bias defined
- 05
What the 2015 review found
- 06
Cultural sensitivity and seeking care
- 07
Vitamin D and chronic disease
- 08
Mechanism versus category
Worked example · free
Trace a diagnostic delay to its source
- 2Training.
- 2Implicit bias.
- 2Research.
Key terms
- Implicit Bias
- A stereotype or prejudice about a group, held without awareness, that can shape clinical judgement.
- Cultural Sensitivity
- Care that respects a patient's language, values and expectations of the doctor-patient relationship.
- Vitamin D Deficiency
- Too little vitamin D in the body, linked in the lecture to many chronic diseases.
Racial Bias in Diagnosis and Treatment FAQ
In what ways does racial bias in medicine harm health?
Through training that shows disease mainly on light skin, implicit bias in clinical judgement and research built on narrow samples. Each can delay diagnosis or change treatment, as in the later Lyme disease diagnoses among Black patients.
Is implicit bias the same as racism?
It is one form of it that operates without conscious intent. A clinician may reject racist views and still hold stereotypes that shape decisions, which is why the 2015 review measured it with implicit tests.
Does vitamin D explain racial health disparities?
Only in part. A 2013 study found socioeconomic factors to be the strongest determinant, while noting that pigmentation-related vitamin D differences may also need to be addressed to close some gaps.
Exam move
For every disparity example in this chapter, write the point in the care process where it arises: training, judgement, research or access. Then name the fix that acts at that point.
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