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Janice A. Sabin, MSW, School of Social Work, University of Washington, PO Box 354900, 4101 15th Ave NE, Seattle, WA 98105, 2065255139, sabinja@u.washington.edu
Health care disparities among racial and ethnic populations are widespread and persistent. After poverty and access to care are accounted for, racial discrimination may explain a portion of disparities in health care that remain. This conceptual paper will focus on health care inequality, specifically, unequal treatment of racial and ethnic groups in the health care system. Health care inequality is a complex issue that must be understood within the broader context of societal racial and ethnic inequality. This paper will first review theories about race and social inequality, to understand how inequality is manifest in American society. I will next explore implicit social cognition theory and implicit racial bias. I will then examine the culture of medicine, theories of medical cognition with attention to the heuristics of medical decision-making and changes in medical cognition over time in clinical practice. I plan to link two separate bodies of theoretical literature: implicit social cognition theory and theories of medical cognition to explain an apparent paradox. Why do health providers, who generally believe in providing quality care for all patients, offer differential treatment to racial and ethnic minorities? My overarching goal is to develop a unified theory of inequality in health care practice. I will examine implicit racial bias as one mechanism that explains how racial and ethnic groups are treated differently in the health care system. I will develop the idea that implicit social cognition combined with strategies used in medical decision-making lead to differential treatment of racial and ethnic groups in health care. Implicit social cognition is defined as the mechanism by which past experience affects current performance despite the fact that the past experience is stored in the unconscious and not consciously retrievable (Greenwald & Banaji, 1995). Medical decision-making relies on use of the subliminal where vast amounts of medical information is stored (Bloche & Nelson, 2002). For a physician to form a diagnosis and treatment plan, large amounts of information must be cognitively accessed, sorted and applied to the clinical situation presented. This process is customarily done under pressure of time. Unrelated information such as social stereotypes may be retrieved along with diagnostic information and affect medical decision-making without the physician’s awareness. This theory will build a theoretical foundation for development of a research experiment to measure physician implicit racial bias and its effect on medical decision-making.
Learning Objectives: At the end of this presentation the participant will be able to
Keywords: Minority Health, Health Care
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.