News & Views

Does your doctor have harmful bias? How the racialized community can protect themselves from medical bias

W. Gifford-Jones MD & Diana Gifford-Jones

June 25, 2020

BY W. GIFFORD- JONES MD & DIANA GIFFORD-JONES

“This week is the first of a two-part column – this week from W. Gifford-Jones and next week from Diana Gifford-Jones – offering our perspectives on race relations and health.”

Racial inequities have been a sore on society for as long as I remember. During my youth, racism was endemic, systematic and blatant. Two occasions stand out from my time at Harvard Medical School, where I had two black classmates. One lived in Atlanta, and when planning a road trip to Florida, I said I’d drop by to see him. He replied, “Don’t do it. This will cause trouble for me.” On another occasion, travelling by train to Boston, I asked a black student to join me for lunch. He replied, “I’m not allowed to go to the dining car.” Both these fine men went on to illustrious medical careers.

But now years later, its clear we still have problems. Not surprisingly, the implications of racial inequities extend to our health. Does race factor in medical decisions? Does it affect treatment? You can bet it does.

The COVID-19 pandemic has shown that North American blacks have not fared well. Blacks have borne 35% of deaths, while they comprise 13.4% of the U.S. population.

Dr. Elizabeth Chapman, Assistant Professor of Medicine at the University of Wisconsin, wrote in the Journal of General Internal Medicine that implicit bias among physicians impacts clinical decision making that perpetuates disparities, even when they strive to deliver equal care. Her research showed that unconscious judgements built on negative stereotypes affects diagnosis, treatment and patient follow-up.

Gender disparity in healthcare is also an issue. One study, published in BMJ Open, reported women were significantly more likely to require three or more pre-referrals before they obtained a consultation for bladder or kidney malignancy as compared to men.

Chapman cites another case in the health journal Mind Over Matter of men suffering chronic obstructive lung disease as being more often correctly diagnosed. Women with the same problem were more likely to be labelled as having a psychiatric problem.

Chapman says autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis and celiac disease, affect women more than men. An American study showed it required 4.6 years before the diagnosis was made in women. During that time women visited 4.8 doctors and 46% were told that they were too concerned about their health and were chronic complainers. Chapman says it’s a deep-seated bias that women’s symptoms are associated with stress and anxiety.

According to Chapman, it’s African American women who receive the worst treatment and that it’s unfortunately a common problem.

Why does it happen? If the doctor has a racial bias, he or she will have a general impression that African American women are more likely to be uncooperative or less likely to do what the doctor has prescribed. Moreover, the gender and race of patients influences whether these doctors follow the usual treatment guidelines.

It’s not only African Americans and women that face physician bias. Chapman points out that some doctors do not understand “normal aging.” This can lead to misdiagnosis for older people. For instance, they may diagnose Alzheimer’s disease when the trouble is a deficiency of vitamin B12.

To overcome bias, Chapman suggests doctors should take the Implicit Association Test, developed by psychologists at Harvard University, the University of Virginia, and the University of Washington. You can try it online.

What can you do to protect yourself from medical bias? Be your own best advocate. You must never forget that you own your body. Get a second, or even a third opinion. Talk with your doctor about your concerns and change doctors if necessary.

I know from long experience that racial issues have staying power. We can see it in our society today, just as evident as when I encountered it as a trainee more than 70 years ago. And I’ll never forget not seeing my black classmate in Atlanta.

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Written By W. Gifford-Jones MD & Diana Gifford-Jones

Dr. W. Gifford-Jones, MD is a graduate of the University of Toronto and the Harvard Medical School. He trained in general surgery at Strong Memorial Hospital, University of Rochester, Montreal General Hospital, McGill University and in Gynecology at Harvard. His storied medical career began as a general practitioner, ship’s surgeon, and hotel doctor. For more than 40 years, he specialized in gynecology, devoting his practice to the formative issues of women’s health. In 1975, he launched his weekly medical column that has been published by national and local Canadian and U.S. newspapers. Today, the readership remains over seven million. His advice contains a solid dose of common sense and he never sits on the fence with controversial issues. He is the author of nine books including, “The Healthy Barmaid”, his autobiography “You’re Going To Do What?”, “What I Learned as a Medical Journalist”, and “90+ How I Got There!” Many years ago, he was successful in a fight to legalize heroin to help ease the pain of terminal cancer patients. His foundation at that time donated $500,000 to establish the Gifford-Jones Professorship in Pain Control and Palliative Care at the University of Toronto Medical School. At 93 years of age he rappelled from the top of Toronto’s City Hall (30 stories) to raise funds for children with a life-threatening disease through the Make-a-Wish Foundation. Diana Gifford-Jones, the daughter of W. Gifford-Jones, MD, Diana has extensive global experience in health and healthcare policy. Diana is Special Advisor with The Aga Khan University, which operates 2 quaternary care hospitals and numerous secondary hospitals, medical centres, pharmacies, and laboratories in South Asia and Africa. She worked for ten years in the Human Development sectors at the World Bank, including health policy and economics, nutrition, and population health. For over a decade at The Conference Board of Canada, she managed four health-related executive networks, including the Roundtable on Socio-Economic Determinants of Health, the Centre for Chronic Disease Prevention and Management, the Canadian Centre for Environmental Health, and the Centre for Health System Design and Management. Her master’s degree in public policy at Harvard University’s Kennedy School of Government included coursework at Harvard Medical School. She is also a graduate of Wellesley College. She has extensive experience with Canadian universities, including at Carleton University, where she was the Executive Director of the Global Academy. She lived and worked in Japan for four years and speaks Japanese fluently. Diana has the designation as a certified Chartered Director from The Directors College, a joint venture of The Conference Board of Canada and McMaster University. She has recently published a book on the natural health philosophy of W. Gifford-Jones, called No Nonsense Health – Naturally!

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