Tuesday, March 26, 2013

Bias in Medicine

Bias may often be found in human reasoning, judgment, and behavior. It may be a tendency or predisposition on the part of a person or entity to make prejudgments about other people or entities or to have preconceived opinions about them or to act on the basis of prejudgments and preconceived opinions about them.
      It may cause a person to invariably view a particular group of people in an approving or disapproving manner, based on that person’s preconceived opinions about that particular group of people. It may thus skew that person's viewpoint regarding that particular group of people, due to the preconceived nature of his/her attitudes and opinions.
      Bias may be sporadic or persistent in its effect, and transient or long-standing in its duration. It may be superficial or deep-seated, overt or covert, recognized or unrecognized.
      Bias in medicine may take the form of racial, ethnic, gender, socioeconomic, geographic, and cultural biases against particular groups of medical patients.
      Examples of biases against particular groups of patients include biases against poor, homeless, and uninsured patients, and biases against black, Hispanic, and LGBT patients. These kinds of bias are obviously unfair and unjust, and it therefore becomes obvious that any kind of bias against patients on the basis of such factors as race, ethnicity, gender, age, sexual orientation, or socioeconomic status is unfair and unjust.
      Targets of unfair and unjust biases may also include particular groups of medical school and nursing school applicants, particular groups of medical students and nursing students, and particular groups of healthcare professionals.
      Bias in medicine may also take the form of cognitive biases on the part of medical providers with regard to the manner in which they undertake medical diagnosis and treatment.
      It may also take the form of intergroup biases on the part of healthcare professionals with regard to the way in which they perceive one another’s professional competence (for example, with regard to the way in which physicians, nurses, physician assistants, and pharmacists view one another’s competence, and with regard to the way in which surgeons, pediatricians, internists, gynecologists, and psychiatrists view one another’s competence).
       It may also take the form of biases on the part of society with regard to the way in which administrative and legislative decisions are made about healthcare resource allocation, healthcare funding, and healthcare system planning.
      Bias may occur on the part of medical providers, educators, administrators, researchers, accreditation and licensing boards, insurance providers, and entire health systems.
      Biases against particular groups of patients may affect the degree of dignity and respect with which they are treated, the degree of autonomy in decision-making that they are allowed, the degree of informed consent that they are permitted in their medical decision-making, and the adequacy of the counseling that they receive from their medical providers about their diagnoses, evaluation, and treatment.
      Biases against particular groups of medical patients may also affect the range of possible diagnoses for their conditions that are considered and confirmed or ruled out, the range of diagnostic services that are offered, the range of treatment options that are discussed and considered, and the timeliness, appropriateness, continuity, and quality of care that is provided.
      Examples of biases against particular groups of patients include the assignment of particular patients to particular hospital beds or wards (those considered least desirable) on the basis of the patients’ race, ethnicity, or financial status. Other examples include the assignment of patients to inexperienced medical providers (medical students or residents) on the basis of the patients’ race, ethnicity, or financial status. Other examples include the lack of inclusion of women and minorities as participants in scientific research that might potentially have favorable implications for their health status, and the lack of availability of medical services for patients belonging to underserved populations (inequitable access to medical care).
      Examples of biases benefiting particular groups of patients include the availability of luxurious VIP hospital wards for affluent patients, the availability of boutique medical practices for affluent patients, the availability of other individualized care options for affluent patients, and various other kinds of preferential treatment affecting access to medical providers and range of medical services offered.
      Examples of biases against women and minorities in medicine include the underrepresentation of women and minorities among medical students, among medical student honor society members, among medical school faculty, and among medical school deans, medical department heads, hospital administrators, hospital board trustee members, medical quality assurance administrators, and medical licensing board members.
      Other examples of biases against women and minorities include
  • biases with regard to admission of minority applicants to medical schools and medical residency programs
  • biases with regard to evaluation of performance of women and minority medical students, residents, and staff
  • biases impacting access to academic and professional mentoring for women and minorities
  • biases impacting assignment of work schedules to women and minorities (with rigid, inflexible work schedules assigned to women who have family as well as professional responsibilities, and with undesirable work schedules consisting of weekend and night shifts inequitably assigned to minorities)
  • biases impacting the level of salary and promotion offered to women as compared to men, and to minorities as compared to non-minorities
  • biases with regard to opportunities for professional advancement
  • biases with regard to recognition of academic and professional excellence.

      Bias in medical research may involve the selection of subjects for study, the medical treatment or lack of treatment offered to human subjects as participants in a study, the assignment of human subjects to various study groups, the distribution of the relative risks and burdens of participation in a study to various groups of subjects, and the distribution of the potential benefits from participation to various groups of subjects. Bias in medical research may also involve the interpretation of study results, and the determination by medical journal editors of the kinds of reports that will be accepted for publication.
      Bias in medicine may also involve decisions made by government agencies regarding funding of medical research, and it may also involve the reporting of study results by medical investigators, scientific journals, and other sources.
      The impression that bias may occur in many ways in the field of medicine does not warrant the conclusion that the medical profession as a whole is biased against particular groups of people, however. Many (perhaps most?) physicians are unbiased in their approach to caring for and meeting the needs of patients. Many (perhaps most?) physicians are also very careful to avoid developing cognitive, social, or professional biases in their roles as care providers, educators, researchers, and administrators. However, the potential for bias to occur throughout the field of medicine reveals that it is a problem that physicians must be very mindful of and on guard against if it is to be avoided, identified, remediated, and corrected.