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Patient Assessment of Physician Is Unrelated to Race or Gender

By February 25, 2020Commentary

The whole world is obsessed with judging people based on their race, gender, religion, ethnic background, etc. instead of their behavior, which would seem the only rational way to judge people.  So now we get lots of research on supposed equity and diversity issues.  One such study was recently reported on Journal of the American Medical Association Network Open.   (JAMA Study)    The authors conducted a randomized trial designed to see if patients reported differently on interactions with physicians based on the doctor’s gender or race.  Using the fact that you can’t actually see anyone in many interactions occurring over the internet, about 3200 online respondents were recruited to respond to a clinical vignette in the emergency room setting in which the treating physician was either male or female or Caucasian or African-American.  The vignette was complicated by the presence of an online symptom checker which gave a diagnosis contrary to that of the ER doctor.  The study participants were asked to rate the physicians on their confidence in him or her, satisfaction with care, likelihood to recommend the doctor, trust in the diagnosis, and likelihood to request additional tests, which could reflect a lack of confidence in what the physician recommended.  Note that the participants didn’t choose the doctors in any way, which mimics the actual emergency room setting.  Physicians were scored on a zero to 100 scale.

White male physicians had an average composite score of 66.13.  White female doctors scored an average of 66.50.  Black female doctors had a mean score of 67.36.  Black male physicians had a mean score of 66.96.  So no statistically significant or really even absolute difference.  And among subgroups of the study subjects by race, gender or other factors, there was also no difference in rating of the various groups of doctors.  In addition, there was no different reported perception of a physician’s warmth or competence.  The authors therefore properly rejected the notion that there may be some bias in favor of white male doctors.  God forbid I could suggest this, but maybe the doctors who report “microaggressions” or discrimination are looking too hard for bias where it apparently doesn’t exist.  Now another reasonable possibility is that people display their biases more often in a direct face-to-face setting, but past research has suggested that while patients may select physicians of a similar race and gender, they don’t rate them differently.  While we should be alert to recognize and address clear examples of any form of discrimination, we should be equally alert to the possibility that allegations of discrimination may not be accurate.

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