- Physicians do not always practice objective, evidence-based medicine but are impacted by their beliefs.
- Physicians’ implicit racial biases have been shown to affect patient treatment and satisfaction.
- In one study, physicians’ political beliefs affected evaluations of drugs promoted by their party.
Imagine a profession designed to serve the public and protect individuals from harm. But then it comes to light that its members are riddled with biases and political beliefs that prevent them from doing their job equitably and that these faulty thoughts lead them to harm defenseless people whom they are serving.
But, rather than wearing blue uniforms and being armed with weapons, members of this profession wear white lab coats and carry stethoscopes.
That’s right, even though we don’t see their wrongs captured on video and they haven’t been subject to protests throughout the nation, physicians are not immune to the negative repercussions of their beliefs.
About 50 percent of physicians admit to being biased against certain groups. But demonstrating a self-serving bias, more than 90 percent claim that their biases don’t affect patient care. Let me explain why I am skeptical and why objective, evidence-based medicine may be more of a myth than you’d think.
Implicit Racial Biases
There is growing evidence that involuntary and unintentional beliefs about social groups—especially based on race—affect the quality of patient care and patient satisfaction. In one experiment, about 300 emergency room (ER) and internal medicine doctors from Atlanta and Boston read a description of a 50-year-old man who presented to the ER with chest pain and an electrocardiogram suggestive of a heart attack. The man’s face was visually altered to appear either Black or white. Those doctors who scored the highest on several tests of implicit bias against Blacks were much more likely to recommend the optimal treatment—thrombolytic drugs—for a white patient but not a Black patient. Their automatic and unintentional beliefs about the worth and cooperativeness of Black patients led to substandard and potentially life-damaging care.
This may help explain why thrombolytic therapy is twice as likely to be recommended for whites with heart attacks and why Blacks are more likely to receive older, cheaper, and more conservative treatments. It may explain other medical inequalities, such as why Blacks with bipolar disorder are more likely to be prescribed ineffective medications with long-term side effects, why Black women are less likely to receive mastectomies, and, when given mastectomies, less likely to be given radiation therapy.
A study in Michigan found that oncologists higher in implicit racial bias had shorter and less supportive interactions with Black patients. The poorer communication impacted patients’ care. When interacting with a doctor with higher implicit bias, patients were worse at remembering what the doctor said, were less confident in the recommended treatments, and perceived greater difficulty completing them.
A separate group of researchers found that Black patients felt worse and perceived their care to be worse when interacting with doctors who were higher in implicit race bias. A study of pediatricians found that doctors with greater implicit pro-white bias were more likely to agree with prescribing a narcotic medication for postsurgical pain for white patients than Black patients.
There is growing evidence that the effects of implicit biases are most clearly seen in aggregate data. For example, police outcomes with minorities are worse in U.S. counties that have the most implicit race bias. Is the same true for objective health care outcomes?
The relevance of subjective, nonmedical beliefs doesn’t end with racial bias or implicit biases against other less studied groups but extends into the political. You may realize that your physician’s political beliefs could affect where they shop, what restaurants they prefer, what neighborhood they live in, and maybe even what music they like, but do you think it could go any further? Could politics intrude into their professional life? Affect their medical judgments? Their decisions about the best course of treatment? The way that they evaluate medical research?
We certainly know that political ideology impacts the way that politicians and citizens view disease.
From the onset, the virus was politicized with the political right minimizing its threat. President Trump and other prominent conservatives called it a “hoax” and a “fraud” and accused Democrats of using the virus to “destroy and demonize the president.” These attitudes from the top filtered down to the general public. At each stage of the pandemic, we found ourselves divided between red and blue, with red America consistently resistant to embracing the danger inherent in the virus. Conservatives were less likely to believe COVID was a threat, less likely to believe in and practice social distancing measures, less likely to accept mask-wearing, and less likely to become vaccinated.
My own work with Thomas Wilson, Davis Whaley, and Daniel Rosenfeld showed that these effects could at least partially be explained by conservative distrust of the mainstream media and beliefs that they were exaggerating the severity of the virus. Once politicized, our partisan lens affected the way we viewed information about COVID. In place of the mainstream media, conservatives embraced alternative sources of information steeped with conspiracy theories about seemingly every aspect of the virus, from its origins to best treatment. In a classic case of motivated reasoning, partisans rejected conclusions that went against their “tribal” identity and sought out information with friendlier implications to their prior beliefs.
But how is any of this relevant for medical doctors who are trained to be objective and deliver the best possible care to their patients? Perhaps more than you’d like to think.
Let’s consider the curious case of hydroxychloroquine. Hydroxychloroquine is an anti-malaria drug that has been proven to be ineffective in treating COVID. The U.S. Food and Drug Administration has reported that the drug also produces serious heart rhythm problems and other safety issues, including blood and lymph system disorders, kidney injuries, and liver problems and failure. Despite its ineffectiveness, hydroxychloroquine has been pushed by those on the right. In about a dozen states, Republican lawmakers proposed—and in some cases passed—legislation to limit medical licensing boards’ ability to take action against providers who prescribed hydroxychloroquine.
According to new research published in the Proceedings of the National Academy of Sciences, from April 2020 to April 2022, conservative medical doctors were more likely to prescribe hydroxychloroquine than their liberal counterparts. This clearly demonstrated that physicians were not objective practitioners influenced by the evidence but were more affected by their political beliefs and the influence of conservative media—the same way laypeople are.
There was even some evidence that doctors were biased by their ideology in how they interpreted the results of medical studies. When a nonidentified drug was presented as inferior in fictitious study results, liberal and conservative physicians agreed in rejecting it. But when the same studies identified the condemned drug as ivermectin, an anti-parasite drug used commonly on animals, there were some discrepancies between liberal and conservative doctors in eschewing the drug. Conservative doctors seemed less able to accurately process information about the discredited drug, which had been promoted by the right.
Together, the two pieces of evidence suggest that the tendency to digest evidence and interpret it favorably to support our prior beliefs—motivated reasoning—isn’t only true for the general public. It also applies to highly evaluated professionals who are sworn to protect patient well-being within the parameters of science. Even with life and death hanging in the balance, motivated reasoning seeps into decision-making.
You may know your doctor’s credentials, such as where they were trained, but how well do you really know them? Their beliefs about hot-button issues like diversity and politics may seem like irrelevant, nonmedical concerns, but emerging research suggests otherwise. Not only do doctors make human errors, but they also make the kind of human errors resulting from their attitudes and values.
Should patients start giving their physicians an implicit bias test and asking them for information about their political beliefs? At the societal level, police officers have been repudiated for killing defenseless Black citizens and for needing to be expunged of bias and problematic beliefs. Why has public outcry not targeted physicians the same way? Is it time for doctors to wear body cameras?
Cooper, L. A., Roter, D. L., Carson, K. A., Beach, M. C., Sabin, J. A., Greenwald, A. G., & Inui, T. S. (2012). The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. American Journal of Public Health, 102(5), 979–987.
Green, A. R., Carney, D. R., Pallin, D. J., Ngo, L. H., Raymond, K. L., Iezzoni, L. I., & Banaji, M. R. (2007). Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. Journal of General Internal Medicine, 22, 1231–1238.
Levin, J. M., Bukowski, L. A., Minson, J. A., & Kahn, J. M. (2023). The political polarization of COVID-19 treatments among physicians and laypeople in the United States. Proceedings of the National Academy of Sciences, 120(7), e2216179120.
Penner, L. A., Dovidio, J. F., Gonzalez, R., Albrecht, T. L., Chapman, R., Foster, T., ... & Eggly, S. (2016). The effects of oncologist implicit racial bias in racially discordant oncology interactions. Journal of Clinical Oncology, 34(24), 2874.