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Joanna Kwiatkowski
27 February 2015
SOC 351
Why Does Your Race Determine Your Care?
The Institute of Medicine report on Unequal Treatment: Confront Racial and Ethnic
Disparities in Health Care is prevalent in the United States health disparities. In their report they
state that, Racial and ethnic minorities receive lower quality healthcare than whites, even when
they are insured to the same degree and when other healthcare access-related factors, such as the
ability to pay for care, are the same. ...although myriad sources contribute to these disparities,
some evidence suggests that bias, prejudice, and stereotyping on the part of healthcare providers
may contribute to differences in care. After reading this quote all I could think was, how is it
that physicians, people that go to school to save lives, are putting others in danger because of
how they look or what their race is. In this paper we will look into different studies and critically
asses how physicians that put a bias to patients are truly harming them in the end.
Do physicians truly know that they are being racist towards their patients, or are they
experiencing aversive racism. According to Jennifer L. Eberhardt and Susan T. Fiske in their
book called, Confronting Racism: The Problem and the Response there is a racism called
aversive racism, aversive racism represents a subtle, often unintentional, form of bias that
characterizes many white Americans who posses strong egalitarian values and who believe that
they are non-prejudiced (p.5). Does this mean that if these physicians are just aversive racists
then it makes it ok for them to put others in danger because they dont believe they are racist. Just
because there is this unintentional form of racism, it does not mean that it is ok for doctors to

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be prejudice. Sadly these doctors with aversive racism or even just plain old racist doctors, are
putting people at risk.
First it is important to discuss how physicians are feeling towards their patients. A study
done by Michelle van Ryn and Jane Burke called, The effect of patient race and socio-economic
status on physicians perceptions of patients that looked at physicians perceptions of all different
types of patients (i.e., white vs. non white, female vs male). The study had provided a significant
finding on how physicians viewed different races. van Ryn, et al. came to the conclusion that,
The results support the hypothesis that physicians perceptions of patients are influenced by
patients race and socio-economic status (van Ryn and Burke, 2000, p. 821). Wait a minute, is
this saying that someones race and socio-economic status should determine what kind of care
they receive? It seems so, the study later presented that the perceptions of the patients had then
influenced the type of treatment that the patient would receive. Physicians believed that,
lower SES [Socio-economic status] patients were rated as less likely to be compliant with cardiac
rehabilitation (van Ryn et al., 2000, p. 821). Since the physicians believed that the patient would
be less compliant then the physician would be less likely to bring up certain treatments. The
physicians that believed, they did not know as fact they just believed, that patient wouldnt
comply would not recommend the treatment. This patients care was now based on belief rather
then evidence that suggests that they should or should not receive the treatment.
In the van Ryn et al. study they find that physicians believed that only 67% of blacks
would be unlikely to abuse alcohol or drugs compared to their white counterparts that 79%
would be unlikely to abuse alcohol or drugs. This belief can put patients at risk for not getting the
proper pain care management that they should. Once again a belief is coming in the way of the

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patients care. In another study done by Knox H. Todd, Christi Deaton, Anne P. DAdamo, and
Leon Goe, it was reported that, The risk of receiving no analgesic was 66% greater for black
patients than for white patients (2000, p. 13). Which makes me wonder if this is because
physicians believe that 33% of blacks would abuse drugs. Are doctors not prescribing pain killers
because they believe that the patient just wants to abuse the drug. Unfortunately, the patients in
turn has to suffer in pain because the physician thinks, does not know as a fact, but rather
thinks that the patient may or may not have a drug problem.
The problem of receiving care does not only relate to pain killers in the emergency room
but also in the type of care that the patients receives with a certain health problem. In a study
done by Edwards L. Hannan, et al. called Access to Coronary Artery Bypass Surgery by
Race/Ethnicity and Gender Among Patients Who Are Appropriate for Surgery it was found that
when the CABG surgery was available to the patients for their heart conditions, 9 out of 10
patients did not receive the procedure because the physician did not recommend it to them.
Another study called The Effect of Race and Sex on Physicians Recommendations for Cardiac
Catheterization found that, the race and sex of the patient affected the physicians decisions
about whether to refer patients with chest pain for cardiac catheterization, even after we adjusted
for symptoms, the physicians estimates of the probability of coronary disease, and clinical
characteristics (Schluman, et al., 1999, p. 623). How can physicians determine a type of
treatment based on thought rather then looking at the facts that are presented to them.
Sadly heart surgery is not the only disease that was discriminated against. A study done
by Peter B. Bach, Laura D. Cramer, Joan L. Warren, and Colin B. Begg unfortunately found that

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black lung cancer patients were less likely then white patients to be recommended for lung
surgery. Surgery and treatment options unfortunately contribute to a larger problem. Without the
proper care patients are at risk for death. The same study that discussed the lung cancer
disparities by Bach et al., they were also able to obtain evidence on patient survival rates after
surgery. It was found that of the 1,000 black patients 640 that had surgery and only 250 had
survived in the first five years. Of the white counterparts 767 had surgery and 329 had survived
in the first five years. How is it possible that of all the patients that received the surgery
significantly more whites had survived then blacks. These findings sadly support the idea that
there is a disparity among white and non-white patients.
The treatment of kidney failure is also right there among lung cancer, heart disease, and
pain suppressants. Just as all three that were previously discussed treatment on kidney failure
also has the same disparities. In a study done by Epstein et al. (2000), it was concluded that only
16.9% of blacks that needed a kidney transplant received one and 52.0% of whites that needed a
kidney transplant received one. These two percentages are significantly different and also prove
the disparities that non-whites have to face day to day.
It is sad to say that with the bias that physicians have on non-white patients we will
continue to have health disparities grow. The question now is how do we fix this racism among
the patients and physicians. Plenty of studies have been done that show evidence of the bias that
physicians have on patients, as well as health out comes because of the disparities that are
prevalent in our lives today. I believe as I am sure many others would as well, that there should
now be studies done to see what there can be done to eliminate these disparities. If there was a
study that had a possible solution to help eliminate disparities then it should be conducted in

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order to help non-white patients receive the care that they deserve to have. Eliminating health
disparities should be essential to physicians because they are putting others lives at risk.
The idea that physicians viewing patients as recalcitrant toward the type of care that the
patient should receive is absurd. Physicians go to school in order to save lives, yet they question
how they should save someone based on their education level and socio-economic status. It is
unethical to think that someone should not receive a type of care because they are unable to
comply with it. I would like to conclude this paper with another quote from the Institute of
Medicines, Unequal Treatment: Confront Racial and Ethnic Disparities in Health Care, The
study committee was stuck by the consistency of research findings: even among the bettercontrolled studies, the vast majority indicated that minorities are less likely than whites to
receive needed services, including clinically necessary procedures (Institute of Medicine 2002,
p.2).

References:
Bach, P. B., Cramer, L. D., Warren, J. L., and Begg, C. B. 1999. Racial Differences in the
treatment of early-stage lung cancer. New England Journal of Medicine
341:1198-1205.
Eberhardt, Jennifer L., and Susan T. Fiske. 1998. Confronting Racism: The Problem and the
Response. Thousand Oaks, CA: SAGE Publications, Inc.
Epstein, A. M., Ayanian, J. Z., Keogh, J. H., et al. 2000. Racial disparities in access to renal
transplantation: Clinically appropriate or due to underuse or overuse? New
England

Journal of Medicine 343:1537-44.

Hannan, E. L., van Ryn, M., Burke, J., et al. 1999. Access to coronary artery bypass surgery by
race/ethnicity and gender among patients who are appropriate for surgery.
Medical Care

37:68-77

Schluman, K. A., Berlin, J. A., Harless, W., et al. 1999. The effect of race and sex on physicians
recommendations for cardiac catheterization. New England Journal of Medicine
326:618-26.
Todd, K. H., Deaton, C., DAmado, A. P., and Goe, L. 2000. Ethnicity and analgesic practice.
Annals of Emergency Medicine 35:11-16.
Institute of Medicine. 2002. Unequal Treatment: What Health Care Providers Need to Know
About Racial and Ethnic Disparities in Healthcare.

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van Ryn, M., and Burke, J. 2000. The effect of patient race and socio-economic status on
physicians perceptions of patients. Social Science and Medicine 50:813-28.