Looking at Bias in Healthcare

By Marie Boone-Clark

There is a commercial where actors, who play doctors on television, talk about healthcare. Their line starts with, “I am not a doctor, but I play one on television.” My dearest says I should say something similar because of my infatuation with medicine. He says my line would be, “I am not a doctor, but I play one in my household.”  I do not entirely disagree. 

I confess to being a medical groupie. Just as some will get excited about a new movie starring their favorite actress, or a new album by their favorite performer, I get excited about new research by highly respected clinicians. I am in awe of how researchers can take seemingly disparate aspects of science and identify potentially life saving protocols and/or products.

Throughout much of my career, I spent time with some amazing physicians and nurses, peeking over their shoulders as they create the magic known as medicine. In this space, I came to realize the sacrifices many make to provide optimal care and as they honed their craft.

When I was introduced to the concept of bias in healthcare and how it impacts patient outcomes, I did not see this research as an indictment of the people I know and respect, but rather an illustration of how we all possess some form of conscious or unconscious bias. 

Dr. Karen Eberhardt, a social psychologist at Stanford University, has revealed the startling, and often dispiriting, extent to which racial imagery and judgments suffuse our culture and society.  If this subject gives you pause, and you are skeptical, take this test.
Who is stronger?

If your answer was “B,” you, my friend, are biased. You see, there is nothing in either picture that would indicate which of the subjects is stronger. You concluded “B” because your perception (née bias) is that men are stronger, when in fact, that is not always the case. While research shows women are approximately 52 percent and 66 percent as strong as the men in the upper and lower body respectively, that does not mean this man is stronger than this woman.

This was a simple exercise, but if you have been guilty of assuming individuals have a particular skill because of their race, or judged a person because of their dress, their last name, or the college they attended, you are guilty of making biased judgments.

The increasing diversity in the United States population is reflected in the patients treated by healthcare professionals. However, research shows this diversity is not represented by the demographic characteristics of healthcare professionals themselves. 

Patients from underrepresented groups in the U.S. can experience the effects of unintentional cognitive (unconscious) biases that derive from cultural stereotypes in ways that perpetuate health inequities. These health inequities are not reserved for adult patients.

According to a peer-reviewed study published in Proceedings of the National Academy of Sciences (September 1, 2020), in the United States, Black babies die at three times the rate of white newborns during their initial hospital stays. But when Black doctors cared for Black babies, their mortality rate was cut in half.

In an interview, Brad Greenwood, the study co-author, and an associate professor of Information Systems & Operations Management Sciences at George Mason University, is quoted as saying a “mix of structural issues could’ve contributed, and each are really disturbing… I don’t think any of us would suggest as co-authors that these results are manifesting as a result of malicious bias on the part of physicians. I also think that underscores how insidious something like this is. Children are dying as a result of just structural problems.” 

It was this study that led Graham’s Foundation to question if we could help better equip parents or preemies to navigate these “structural problems.”

We sought out the knowledgeable expertise of Valencia Walker, MD, Associate Chief Diversity and Health Equity Officer Nationwide Children’s Hospital and Associate Division Chief for Health Equity and Inclusion Department of Pediatrics l Division of Neonatology at The Ohio State University College of Medicine, to help us answer this question and to lead an advisory council.  

Additional members of the Advisory Council are:

·        Noredia Itohan Alile, MD – Neonatologist at Advocate Health Care, Chicago

·        Alice Obuobi, MD – Medical Director at Texas Children’s Hospital

·        Joy Henderson, PhD, RN, PhD – Assistant Professor at Pace University – College of Health Professions and Manager, Regional Perinatal Centers, New York Presbyterian Hospital

·        Kimberly Taylor-Campbell, RN – Director of HCPPA on the Maternal Mortality Reduction Project as a Certified Healthcare Simulation Educator (CHSE) nurse educator for NYC Health and Hospital System’s Simulation Center

The Advisory Council has articulated our objective as two- fold:

• Build an innovative and sustainable initiative to educate and empower BIPOC* parents of preemies so they can adequately advocate for their baby at every stage.
  
• Create initiatives that interlace inclusivity, empathy, and cultural humility to offer relevant, culturally competent resources and support.

As the council moves forward with their work, we are committed to providing more meaningful updates on this project. 

Marie Boone-Clark has over thirty-five years of experience in infant nutrition, having held numerous positions at Mead Johnson Nutrition. This exposure led to her passionate support for organizations like Graham’s Foundation.