Susan Moore, MD, tragically passed away from COVID-19 in December. Before she died, she complained to her son that she was being mistreated by the medical staff because she is Black. She said that her doctors were doubtful of her complaints of worsening symptoms and dismissive of her requests for pain medication. She said they treated her like she was a drug addict. As an internal medicine physician herself, she felt that her doctors’ perception of her race impacted the care she received.
Moore’s tragic story received national media attention. She became a poster child for the double standard that minority patients often experience within the healthcare system. Thankfully, new light is being shed on the prevalence of how providers misperceive patients. These misperceptions are often caused by medical, social and financial factors, but concrete actions to address these issues can help reduce health disparities and save lives in the future.
New studies have identified significant health disparities that Black women experience during pregnancy. Failure by physicians to understand these medical risks means a higher likelihood of adverse outcomes. Add to this the potential misperceptions by healthcare providers for Black patients as misrepresenting their symptoms, as Moore experienced, and the risk of tragedy only increases.
These examples demonstrate how a healthcare professional’s perception of a patient can impact the care they provide. Misperceptions are often caused by unconscious bias. Though often unintentional, unconscious bias reinforces inaccurate assumptions about different groups of people.
A 2013 study demonstrates unconscious bias relative to gender. The study had a male and female patient describe identical knee pain symptoms to the same set of physicians, yet, the male patient received significantly different information and advice than the female patient. The physicians provided less medical information and less encouragement to undergo knee replacement surgery to the female patient than to the male patient. If the patients described the exact same symptoms, should they not have received similar medical advice?
Not all of these biases are unconscious. Similarly, not every bias – whether conscious or unconscious – is related to a medical condition. In many cases, providers draw biases from social risk factors. These biases are exacerbated by the financial incentives of new value-based payment models.
This is particularly true when it comes to how providers behave under models that tie their reimbursement to the cost and quality of the care they provide. Value-based payment models use competition-based incentives to reward providers for achieving high scores on quality and cost containment metrics. However, these models lack a risk adjustment mechanism that adequately accounts for medical complexities and social determinants of health.
A recent survey of orthopedic surgeons asked if they feel pressure to avoid or restrict access to patients with limited social support. The survey results indicate that surgeons indeed feel such pressure. As minorities are more likely to require costly post-surgical support, value-based payment models may increase existing disparities for minorities who are perceived to be less profitable in such models.
What’s more, research shows that doctors are more likely to document a patient’s race if they are Black than if they are white. Why is it more important to document a patient’s race if they are Black? This bias has the potential to reinforce misperceptions like those identified by the survey of orthopedic surgeons.
These misperceptions and biases will disproportionately impact minorities and women. As with Moore, a misperception can have harmful and deadly consequences for patients. It is not too late to protect patients from the consequences of misperceptions. The perception of risk, whether it is based on medical, social or financial factors, influences decision making.
There are many ways to address these issues. Calling attention to misperception and training providers to recognize their biases is an important first step. Such bias training needs to be mandatory and incorporated in all healthcare provider training and recertification. Quantifying patients’ perceptions of potential discrimination in their healthcare experiences with existing tools will identify opportunities for more equitable care.
Improving how payment models adjust for patient risk is a more complicated but critical solution. Even if we overcome medical and social misperceptions, the flawed financial incentives of value-based payment models will still exist. If providers were not pressured by the financial incentives of payment models, they would not feel pressure to avoid complex patients.
Only by addressing all these issues will we avoid the tragic death of the next Susan Moore.
Mary I. O’Connor, MD, is chair of Movement is Life, a multi-stakeholder organization dedicated to promoting health equity, and the chief medical officer at Voya Health.
Source: MedicalNewsToday.com
