Personalized Medicine: the belief that diagnostic testing of a single patient, combined with his or her medical history, will yield targeted treatment options and better overall healthcare. This healthcare movement takes center stage in cancer treatment, where cutting edge research on genetics, immunology, and biotechnology are brought in to tackle one of the most devastating and prevalent diseases. The term “personalized medicine” itself provides some form of comfort for those patients; the knowledge that a physician is zealously fighting for their lives. It has become a shining beacon of how much our medicine has progressed. Yet for all the progress in individualized medicine, a new study from the University of Virginia reveals that some physicians let racial misconceptions, and generalizations about race affect their professional judgment in pain management for black Americans.
The UVA study builds upon the documentation that black Americans are systematically undertreated for pain because of race-based assumptions (usually tied to substance abuse), and adds that biological misconceptions leading to generalizations attributed black Americans may also play a role in the systematic undertreatment. The researchers first recruited 121 laypeople, 92 of whom were US-born white, and found that 72 percent of the white people in the sample endorsed at least one false belief about how black people experience pain, such as thicker skin in black people, less sensitive nerve endings, and/or slower aging process. The researchers then asked “white medical students and residents, 222 participants in total, to rate on a scale of zero to 10 the pain levels they would associate with two mock medical cases, a kidney stone and a leg fracture, for both a white and a black patient, and to recommend pain treatments based on the level of pain they thought the patients might be experiencing.” They were also about the veracity of those same biological misconceptions that the laypeople were asked. Half the medical students and resident group endorsed at least one of the misconceptions. Moreover, those that did endorse a misconception were “more likely to report lower pain ratings for the black vs. white patient, and were less accurate in their treatment recommendations for the black vs. white patient.” To test the accuracy of the suggested treatment results from the medical scenario, researchers presented the same medical scenarios to more experience physicians. The majority of those experienced physicians recommended a narcotic to ease pain, inline with World Health Organization guidelines. “Importantly, white medical students and residents who did not endorse these false beliefs did not show the same bias.”
What this study shows is that although our society has progressed in viewing the patient as a unique entity—culminating in the beacon that is “individualized” or “personal” medicine—the same misconceptions and stereotypes born from hate and prejudice in our blighted history still prevail to this day and persist in one area of medicine, while another touts their wholesome custom approach.
To prevent his sort of racial profiling in the physicians of tomorrow, university counsel and hospital legal departments may be a key resource. Classes or seminars aimed at dispelling such misconceptions at an early stage in a medical student’s or resident’s career can prevent such biases, and lead to better healthcare down the line. It may also protect the hospital from malpractice or negligence lawsuits if physicians carefully diagnose and actually treat each patient on an individual basis, instead of applying centuries-old false beliefs about biological differences in race. In fact, a study from the Mayo Clinic concluded that “African Americans have better outcomes for five common gastrointestinal diagnoses when treated in hospitals with higher inpatient racial diversity.”
Diversity, and training to handle diverse patients is essential in healthcare, and any hospital that dares espouse “personal” or “individualized” treatments needs the help of legal advocates to make sure that there should never be a casualty due to racial bias.