One in five patients report discrimination in healthcare

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One in five older Americans experience discrimination from doctors and healthcare providers, new research reveals.

Black patients were most likely to report racial discrimination, while whites and Hispanics felt that their treatment was influenced by their age, weight or income.  

Recent reports have found that many members of the aging US population are not seeking medical attention when they need it, and discrimination could further discourage older people from taking care of their health.

Over the period of the study – between 2008 and 2014 – rates of discrimination reported by blacks fell – perhaps in line with the introduction of training to make medical students aware of bias – but the high overall incidence of discrimination warrants further efforts, the authors say. 

Older black patients still report more discrimination than whites or Hispanics, though numbers remain near 20 percent across for patients of every  race, according to a new study

Older black patients still report more discrimination than whites or Hispanics, though numbers remain near 20 percent across for patients of every  race, according to a new study

Older black patients still report more discrimination than whites or Hispanics, though numbers remain near 20 percent across for patients of every  race, according to a new study

Researchers surveyed nearly 14,000 patients over the age of 54 who suffered from chronic diseases. 

They kept up with the patients as they made regular hospital visits between 2008 and 2014 for common ailments of old age: hypertension, diabetes, cancer, lung disease, heart disease or stroke. 

Depending upon what race or heritage they were, doctors and health care workers discriminated against patients for different reasons, by the patients reports. 

Black patients still report discrimination at the highest rates, though unfair treatment dropped from 27 percent to 20 percent. 

About half of black patients felt that their providers discriminated against them based on their race, while age and economic discrimination accounted for 29 and 20 percent of overall reports. 

The authors note that in recent years, more medical schools have implemented courses to train future doctors to be cognizant of and combat the influences of stereotyping and their own experiences. 

‘Institutions have put a lot of effort into cross-cultural training and sensitivity in provider’s office and medical schools have done a lot to recruit new doctors based on compassion rather than GPAs,’ says Dr Peter Muennig, a professor at the Columbia University Mailman School of Public Health.

While reporting of discrimination among blacks dropped precipitously from 2008 to 2010, the decline tapered off after that, for unclear reasons, the report states. 

Regardless, public health continues to bear out that black patients are at greater risks for chronic diseases and face worse outcomes than do White patients. 

‘A good deal of info that shows that African Americans receive lower care than virtually any other group, other than potentially Native Americans,’ Dr Muennig says.

‘This is based on ‘differences in access to quality care and the care provider’s racial bias,’ he says.

 Clearly, people who are affluent, whites and Asians are more likely to get good medical care, though, it’s hard to say even what good medical care is…it might even be too much
Dr Peter Muennig, Columbia University Mailman School of Public Health

Dr Muennig says that stereotypes are deeply ingrained and go both ways: ‘Providers discriminate against patients, and patients discriminate against providers.’ Racial stereotypes are very strong, and they penetrate even within the racial groups that are susceptible to them.’

Prevailing media stereotypes of minorities as being more likely to use drugs and commit crimes play in heavily to health care providers’ discriminatory tendencies.

Dr Muennig cites a study that found that care providers were ‘much less likely to give adequate pain management for a fractured femur if the patient was black or non-white Hispanic. 

‘It’s a very painful injury, and probably has to do with the [assumption] that if you’re black, you’re more likely to be using drugs,’ he says. 

On the other hand, ‘clearly, people who are affluent, whites and Asians are more likely to get good medical care, though, it’s hard to say even what good medical care is.’

For white and affluent people, good care ‘might even be too much,’ leading to over-prescribing, ‘compared to other groups,’ Dr Muennig suggests.  

The disparity in mortality for blacks and whites has finally begun to narrow, according to the latest data from the Centers for Disease Control and Prevention (CDC).

The gap is down from 33 percent in 1999 to 16 percent as of 2015, but that is still a difference of about three and a half years of life between the two races. 

Counterintuitively, the wealthier black patients were, the more likely they were to report discrimination, while the opposite was true for Whites. 

University of California, Berkeley epidemiology professor and study author Dr Amani Nuru-Jeter said: ‘This finding is useful for continued efforts to improve healthcare experiences and suggests that a one-size-fits-all approach will not suffice.’ 

In a socially conservative industry like medicine, personal responsibility spills over to size, weight, socioeconomic status, race…things people would change if they could
Dr Peter Muennig, Columbia University Mailman School of Public Health

For Hispanics, the greatest cause for concern was their age, with 27 percent reporting discrimination on that basis. 

Not far behind, 23 percent of Hispanic participants said that they were discriminated based on race, while financial status and weight or physical appearance each accounted for 14 percent of discrimination. 

Both whites and Hispanics felt discriminated for their weights, and Dr Muennig says that’s a common phenomenon in the medical industry. 

This is ‘huge issue, an area where you see things changing by race. Heavier people experience discrimination based upon any measure you can think of in a medical office,’ he says. 

Doctors, as a group, tend to be ‘socially conservative,’ and have high standards for personal responsibility, Dr Muennig says. 

‘In a socially conservative industry like medicine, personal responsibility spills over to size, weight, socioeconomic status, race…things people would change if they could.’ 

‘Overweight and obese people are given messages that they would be more successful, healthier and look better if only they could lose weight’ by doctors who, he says, use ‘negative terms’ to describe these patients among themselves.

White patients said that they were discriminated against only slightly less often than did blacks, at 17 percent overall. But the reasons they believed they were treated unfairly were quite different. 

Nearly 30 percent of whites said that the care they were given was influenced by their ages. Other forms of discrimination were relatively low, though whites were the only group to report gender as a common enough for discrimination for the authors to report the finding. 

‘If people believe they have received unfair treatment in the health care setting, that experience could negatively affect their experience with their providers, their willingness to go to their providers, and their adherence with their treatment, and thereby affect their health,’ said Dr Thu Nguyen, ScD, MSPH, a University of California, San Francisco researcher and the paper’s first author.

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