The strangest of all encounters: racial and ethnic discrimination in US health care
The strangest of all encounters: racial and ethnic discrimination in US health care
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DOI：
10.1590/0102-311x00104416
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发表时间：
2017-01-01
期刊：
影响因子：
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通讯作者：
James, Sherman A.
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文献类型：
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作者：
James, Sherman A.
2003年，美国国家科学院医学研究所的一个委员会总结了数百项研究，这些研究表明，美国少数民族，特别是非洲裔美国人，在各种各样的情况下，获得的医疗保健质量都比他们的白色同行差。在控制了社会人口因素和患者支付医疗费用的能力之后，这些种族在医疗保健方面的差异仍然存在。委员会的结论是，医生对非裔美国人以及其他有色人种无意识的负面刻板印象可能导致了这些医疗保健差异。本文选择性地回顾了2003年以后发表的关于医生无意识偏见对美国医疗差距的可能贡献的研究。所有的研究都使用了内隐联想测试，该测试量化了个体与黑人或拉丁美洲人相比，将诸如“聪明”等积极属性与白人相关联的相对速度。除了评估医生对患者的无意识态度外，一些研究还关注医患沟通的行为和情感维度，例如医生的“言语优势”和患者是否感到受到尊重。回顾的研究发现，在医生对患者的态度和与患者的互动中存在“亲白人”的无意识偏见，尽管一些证据表明黑人和女性医生可能不太倾向于这种偏见。白色医生和少数种族/族裔之间在医疗环境之外的有限社会接触，加上医生在遇到有复杂健康问题的患者时经常面临的严重时间压力，可能会增加他们对无意识偏见的敏感性。
In 2003, a Committee of the Institute of Medicine of the National Academy of Sciences summarized hundreds of studies documenting that US racial minorities, especially African Americans, receive poorer quality health care for a wide variety of conditions than their White counterparts. These racial differences in health care persist after controlling for sociodemographic factors and patients' ability to pay for care. The Committee concluded that physicians' unconscious negative stereotypes of African Americans, and perhaps other people of color, likely contribute to these health care disparities. This paper selectively reviews studies published after 2003 on the likely contribution of physicians' unconscious bias to US health care disparities. All studies used the Implicit Association Test which quantifies the relative speed with which individuals associate positive attributes like "intelligent" with Whites compared to Blacks or Latino/as. In addition to assessing physicians' unconscious attitudes toward patients, some studies focused on the behavioral and affective dimensions of doctor-patient communication, such as physicians' "verbal dominance" and whether patients felt respected. Studies reviewed found a "pro-white" unconscious bias in physicians' attitudes toward and interactions with patients, though some evidence suggests that Black and female physicians may be less prone to such bias. Limited social contact between White physicians and racial/ethnic minorities outside of medical settings, plus severe time pressures physicians often face during encounters with patients who have complex health problems could heighten their susceptibility to unconscious bias.