Disparity in Medical Diagnosis

Changes happen as time goes on. This was no different when the French Revolution took place during the late 1700s in France and in 1760 when the Industrial Revolution began in Great Britain, Europe, and the United States. Both instances led to societal and political changes as well as technological advancements. Specifically, these changes and advancements in technology have led to income inequality, the continuity of racial discrimination, as well as gender discrimination. These instances are seen repetitively in professional, medical, and recreational settings.

One could even argue that a medical setting is also a professional setting. Doctors, nurses, and other healthcare workers are expected to carry themselves in a professional manner (hence the reason a medical setting is also considered that of a professional one). They’re also expected to remain unbiased and think with open minds. This is because one mistake, judgement or action has the possibility of changing the lives of a patient, either positively or negatively.
These instances do happen in One could wonder why the focus is on medical settings and not a different settings and professions, but our focus will be on the medical setting in different settings, the focus will be on medical settings; specifically on how socioeconomic income, race, as well as gender bias have led to a disparity.

Many of the issues having to do with disparity in medical diagnosis are interconnected, race with socioeconomic status, and implicit bias with race, socioeconomic status and even gender.
The interconnection between race and socioeconomic status stems from the history of the United States. Slavery is intertwined with the history of the United States along with the laws that have been passed. Even after slavery was abolished white people, who were the majority and had the most political power, saw themselves as superior to black people. According to National Library of Medicine, “in 1944, a majority of white persons (55 percent) indicated that white people should have the first chance at any kind of job”. They already had much of an advantage when it came to getting hired due to their white privilege and the law being in their favor, yet they still thought that another privilege was needed on top of their many others. This text also goes into depth on the effect that negative stereotypes on black people ahs had an impact on their ability to get affluent jobs/positions as well as homes. This in turn influences their insurance packages: “Compared with white persons, black persons and other minorities have lower levels of access to medical care in the United States due to their higher rates of unemployment and under-representation in good-paying jobs that include health insurance as part of the benefit package”. With a non-existent health insurance or health insurance that isn’t up to par, it isn’t a surprise that many black people go undiagnosed for many diseases. Not only that but many can’t afford medical expenses, so they avoid going to hospitals to receive medical care.

The expense for medical attention isn’t the only thing impacting the help that black people need and the disparity they face when it comes to medical diagnoses. Another reasoning behind the disparity of medical diagnosis in the black community is implicit bias. And according to Patient Engagement Hit medical providers unconsciously have these biases that they implement when having communication with black people and people of color. While a provider may not realize that they are behaving this way, patients do recognize the bias. This in turn makes patients feel uncomfortable and they will most likely not want to receive care as often. With implicit bias “some providers may limit the depth of shared decision-making or explanations of medical concepts because their implicit bias tells them a patient does not have the health literacy to fully engage with her care”. With the very little information received by providers because of this internal but unconscious bias along with the patients being distanced because they recognize this bias, it doesn’t come as a surprise that black patients and those of color, aren’t receiving the care they need in medical settings.

Implicit bias is also related to the disparity in medical diagnosis in relation to socioeconomic status. The relation between socioeconomic status is very much close to the point of which one can’t talk about one without mentioning the other. The reality being that (in the United States) “African-Americans, Latinos, and the economically disadvantaged experience poorer health care access and lower quality of care than white Americans”, according to Forbes. Its not to say that white people can not be poor or struggle, but instead that majority of those that struggle, and face socioeconomic problems are black and Latino. Medical care in America is expensive and those who cannot afford it avoid going to the hospital to seek medical attention or advice unless necessary. This can even be until symptoms of an unknown disorder get out of hand, which at that point because of the lack of care may be irreversible.

Furthermore, the history of America plays a huge part in this. Segregation and several policies that prevented those in black and colored communities from receiving adequate care have had a long-term effect on their access and continue to do so. According to the National Library of Medicine, “Despite the unprecedented explosion of scientific knowledge and the phenomenal capacity of medicine to diagnose, treat and cure disease, Blacks, Hispanics, Native Americans, and those of Asian/Pacific Islander heritage have not benefited fully or equitably from the fruits of science or from systems responsible for translating and using health sciences technology”. Because access has improved many assume that all have access, and this couldn’t be further from the truth. While access has improved, the diseases and disorders that have already presented themselves in these communities and families due to lack of access have already left their mark. They have been introduced into bloodlines and getting rid of them is a hassle.
An example of the interconnectedness of these different issues as well as the effect racism has had on the disparity of medical diagnosis long-term is diabetes. A black or brown family (one that isn’t white) didn’t have access to fruits, vegetables, and other nutrients because they couldn’t afford it and their race. Their race prevented successful businesses that had all these things, so they had to make do with what they had. Not eating healthy and not having access to medical care or an education on what should or shouldn’t be eaten leads to someone developing diabetes. If one person in this environment develops diabetes the chances are that others have also developed it since they live under the same circumstances. If they had access to healthcare, they would have known when they were pre-diabetic. These policies that were put into play were in effect for over 50 years and oversaw the birth of more than one generation of families living in those same conditions. Meaning no change in circumstance with the same living conditions and allowing more and more of the same communities to develop disorders and disease like diabetes, which is hereditary.

Another factor that has also impacted the disparity in medical diagnosis is gender and the bias that follows: “Gender bias can be conscious, and something someone is aware that they have. Gender bias can also be unconscious, or something a person is not aware of.” Whether it is known or not, this bias is the same as the others in the sense that it is also hard to get rid of. Gender bias isn’t specific to one gender but it more prevalent for women. Many women patients that experience pain as a symptom are dismissed and are seen “as too sensitive, hysterical, or as time-wasters,” according to Medical News Today. Because of the stereotype that women are dramatic and sensitive, doctors second-guess their symptoms.
This mindset also impacts women who are trying to get assessed for deadly diseases such as cancer and autoimmune diseases.

In one way or another, several reasons for the disparities in medical diagnosis relate to implicit bias. There needs to be a change made within medical institutions themselves. Change needs to start somewhere. Doctors and those in medical positions must try their best to unlearn these internalized stereotypes and biases that they may have, which is not as easy as it sounds, which is why hospital administrators should lend a hand in this effort. A couple of ways that hospitals and the healthcare system can help with this fight against disparity include:

1. Hospitals can create programs that discuss implicit bias and its impact on patients short-term and long-term and mandate personnel attend a certain number of hours each quarter.
   i. These programs can also include sessions that discuss stereotypes which are the foundation of implicit bias.
   ii. Statistics should be shown as well as real life accounts to humanize the statistics and help them further understand the detriment that any one of their decisions that are especially influenced by implicit biases, could have on patients.
2. Open donations or allow others to donate to those who are not able to afford medical bills and such.
3. Create pamphlets educating about the different struggles that any patients could be facing.
4. Doctors should hold each other responsible when they notice a coworker behaving in a way that makes a patient uncomfortable.
5. Create a system where patients could leave reviews on how they were treated or felt during their appointment or receiving treatment.
   i. My belief is that this should be anonymous so that patients don’t feel uncomfortable, and it also avoids any invasion of private on their end.
   The only way to go about these changes is to educate, a common theme that can be seen throughout the suggestions mentioned beforehand. This attempt at change should be continuous and shouldn’t end once a hospital/medical facility notices a slight positive change in patient treatment; consistency is key. Again change such as this isn’t easy but it is necessary in order to combat the disparity that different marginalized groups are facing in medical diagnosis.

Cited Sources:

1. Williams, D R, and T D Rucker. “Understanding and addressing racial disparities in health care.” Health care financing review vol. 21,4 (2000): 75-90.
2. PatientEngagementHIT. “What Is Implicit Bias, How Does It Affect Healthcare?” PatientEngagementHIT, 20 Oct. 2020, patientengagementhit.com/news/what-is-implicit-bias-how-does-it-affect-healthcare.
3. Robert Pearl, M.D. “Why Health Care Is Different If You’re Black, Latino or Poor.” Forbes, Forbes Magazine, 6 Mar. 2015, www.forbes.com/sites/robertpearl/2015/03/05/healthcare-black-latino-poor/?sh=40ce65a77869.
4. Racial and Ethnic Disparities in Diagnosis and Treatment: A Review of … https://www.ncbi.nlm.nih.gov/books/NBK220337/.
5. MediLexicon International. (n.d.). Gender bias in medical diagnosis: Facts, causes, and impact. Medical News Today. Retrieved May 6, 2022, from https://www.medicalnewstoday.com/articles/gender-bias-in-medical-diagnosis#what-is-gender-bias