Bias in Healthcare

NARRATOR: How do you know if a face is alive?

For most of us, this isn’t a hard decision.

Take a look at this face.

Is it alive? Can it feel pain?

It should take a fraction of a second to decide: of course not. That’s a Ken doll in his 50s; it’s not a real human. It can’t feel pain. It doesn’t have a mind.

So here’s the more interesting question: where is the tipping point?

Just how “human” does this face need to be for us to start thinking “Okay, there’s a mind in there. This face can feel pain.”

According to psychologists at Dartmouth, the average answer here is about 67%.

Once a face is about 67% human, it looks alive, it looks like it has a mind, and it looks capable of feeling pain.

But this threshold isn’t set in stone. Research shows that if the face in front of you is somehow not like you—let’s say it’s a student from a rival school, someone who has different politics, or even someone from a different racial or ethnic group—these faces (the faces of outgroups) now have to be significantly more human than an in-group face before you’re willing to say they can think or feel.

This isn’t a conscious decision. It’s an implicit bias in perception, ticking away in the background of our minds.

And there’s a natural question that follows: if it’s harder for us to see some faces as “capable of feeling pain,” could this make harming them easier? Even when we’re looking at people who are undeniably 100% human?

It’s possible.

NFL injury reports have shown that Black football players are deemed “okay to play” more often than White players with similar injuries.

And in healthcare, hundreds of analyses show that Black Americans are less likely to receive pain medication than White Americans reporting the same level of pain.

This is true in big cities and small towns, across socioeconomic class, and for many different kinds of pain.

It’s even true for children suffering from appendicitis.

MONICA K. GOYAL, M.D.: Essentially, what we found was when children were presenting with similar levels of pain, Black children had 80% lower odds of receiving opioid medications.

NARRATOR: The simple truth is we see some people’s pain differently. Psychologist Kelly Hoffman and colleagues found that many of us, including medical personnel, implicitly hold the false idea that Black people feel less pain than White people.

From simple paper cuts to slamming a hand in a car door, the same injury was judged to be “less painful” in her experiments when it happened to this Sam rather than this one.

And this is a bias that affects more than just how we see others’ pain. It can also impact how we treat it.

The medical students and residents who showed the greatest bias when they did this task were not only more likely to endorse false statements like “Black people have thicker skin than White people”; they were also more likely to make inaccurate treatment recommendations for Black patients.

Now remember, these experiments aren’t studying explicit bias. After all, these are doctors — a population of people who have pledged to do no harm. But no matter who we are, hidden biases in our minds can influence what we see—and then how we act.

So let’s talk about solutions.

When it comes to pain management, Professor Mahzarin Banaji has an idea for hospitals – an “in the moment” intervention:

MAHZARIN BANAJI: You type in a painkiller that you want to prescribe to a patient into your electronic system—let’s say Codeine. Your software should return a little graph to you that says “Please note: in our hospital system this is the average amount of painkiller we give to White men, this is the average painkiller we give to Black men for reporting the same level of pain.

You’re the doctor. You’re the expert. Only you can decide what is right for your patient. But it is important to do so with awareness of the pattern of bias in your own healthcare system.

NARRATOR: This carves out a moment for double-checking decisions. Sometimes a well-timed reminder is all we need to outsmart our minds.