Doctors' Unconscious Bias Affects Quality Of Health Care Services, Research Shows
AILSA CHANG, HOST:
People of color have been disproportionately impacted by the coronavirus. They are more likely to have frontline jobs that expose them to it and more likely to have the underlying conditions that make COVID-19 worse. But the racism embedded in the health care system might also play a role. From member station KQED in San Francisco, April Dembosky reports that some hospital systems are trying to fix that.
APRIL DEMBOSKY, BYLINE: Back in March, Karla Monterroso went hiking in Utah with some friends. She flew home through the Las Vegas airport. And four days later, she started feeling sick.
KARLA MONTERROSO: I had a full, bad, dry cough. It was like my lungs felt really sticky, and my fevers were ridiculous.
102.3, I believe.
DEMBOSKY: She kneeled in the shower on all fours, ice-cold water on her back, willing her fever to go down.
MONTERROSO: That night, I had written down in a journal letters to everyone, like, in case I died.
DEMBOSKY: She was sick for another month. Then came a new batch of symptoms...
MONTERROSO: Like a headache all...
MONTERROSO: I had shooting pains in my legs.
DEMBOSKY: ...And sharp pain in her legs and abdomen.
MONTERROSO: I had seen so many of the reports of people having strokes around my age range, about blood clots and being really afraid of that.
DEMBOSKY: Still, she wasn't sure if she should go to the hospital.
MONTERROSO: As, like, women of color, you get questioned a lot about your emotions and the truth of your physical state. You get called an exaggerator a lot throughout the course of your life.
DEMBOSKY: It took four friends to convince her that she needed to call 911. But when she got to Alameda Hospital, her worst fears were validated.
MONTERROSO: The doctor came in and said, I don't think that much is happening here. I think we can send you home.
DEMBOSKY: Karla had a couple friends on the phone to help her, and they started asking questions. What about Karla's high heart rate, her low oxygen levels? Her lips are blue.
MONTERROSO: And he was like, I'm not doing this.
DEMBOSKY: He walked out of the room.
MONTERROSO: You know, he comes in. He wants to talk about my friend's tone and, like, my tone.
DEMBOSKY: Karla said she didn't want to talk about her tone. She wanted to talk about her health care. She was worried about blood clots in her leg, and she asked for a CT scan.
MONTERROSO: And he was like, well, you know, the CT scan is radiation right next to your breast tissue. Do you want to get breast cancer?
DEMBOSKY: He didn't order the test. At nearly every turn, Karla says her concerns were dismissed. Her cycling oxygen levels - the machine's wrong. The shooting pain in her leg - probably just a cyst. Karla just wanted to get out of there. Her friends picked her up and drove her to UC San Francisco.
MONTERROSO: And one of the nurses came in, and she was like, I heard about your ordeal. I just want you to know that I believe you. And we are not going to let you go until we know that you are safe to go. And I started bawling (laughter) because that's all you want - right? - is to be believed. And you spend so much of the process not believing yourself. And then to, like, not be believed when you go in is really hard to be questioned in that way.
DEMBOSKY: A series of tests at UC San Francisco ruled out a blood clot. Karla went home stabilized but rattled. Alameda Health System declined to comment on Karla's experience. She believes that what happened to her helps explain why people of color are faring so badly in the pandemic.
MONTERROSO: Because when we go and seek care, if we are advocating for ourselves, we can be treated as insubordinate. And if we are not advocating for ourselves, we can be treated as invisible.
DEMBOSKY: Experts say this happens frequently and regardless of the doctor's intentions or race. For example, Karla's doctor was not white. Dr. Rene Salazar is the assistant dean for diversity at the University of Texas at Austin medical school. He says research shows every doctor, every human being, has biases they're not aware of.
RENE SALAZAR: Do I question a white man in a suit who's coming in looking like he's a professional when he asks for pain meds versus a Black man?
DEMBOSKY: Unconscious bias most often surfaces in high-stress environments like emergency rooms, where doctors have to make quick, high-stake decisions. Add in a deadly new virus where the science is changing by the day, and things can spiral.
SALAZAR: There's just so much uncertainty.
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DEMBOSKY: At Kaiser Permanente health system, Dr. Ronald Copeland is working to improve this. He says in the early days, doctors resisted training.
RONALD COPELAND: It was viewed almost from a punishment standpoint. Doc, your patients of this persuasion don't like you, and you've got to do something about it. And it's like you're a bad doctor, and so your punishment is you have to go get training.
DEMBOSKY: These days, Kaiser's approach is rooted in data from patient surveys. Now, these questionnaires don't ask if you think your doctor was racist, but they do ask if you felt respected...
COPELAND: Trust building, empathy...
DEMBOSKY: ...If the communication was good.
COPELAND: ...Communication effectiveness.
DEMBOSKY: Kaiser then breaks this data down by demographics to see if maybe a doctor gets good scores on respect and empathy from white patients but not Black patients.
COPELAND: If you see a pattern evolving around a certain group and it's a persistent pattern, then that tells you there's something that - from a culture or from an ethnicity, from a gender - something that group has in common that you're not addressing. Then the real work starts.
DEMBOSKY: Copeland says when you reframe the goal of training around getting better patient outcomes, doctors want to do it.
COPELAND: Folks don't flinch about it. They talk about it. And they're eager to learn more about it, particularly about how you mitigate it.
DEMBOSKY: Karla Monterroso is glad that training is happening but says it needs to be more widespread. Karla is the CEO of a nonprofit for racial equity in tech, and she says even for her, it took an army of friends and activists fighting for her just to be heard.
MONTERROSO: Ninety percent of the people that are going to come through a hospital are not going to have what I have to fight that. And if I don't say what's happening, then people with much less resources are going to come into this experience, and they're going to die.
DEMBOSKY: It's been nearly six months since Karla first got sick, and she's still not feeling well. She recently moved to LA so she could be near her family for her recovery.
For NPR News, I'm April Dembosky in Oakland.
CHANG: This story is part of a partnership with NPR, KQED and Kaiser Health News.
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