The doctor will judge you now

By Carina Storrs, Special to CNN | 1/19/2016, 2:02 p.m.
If you are overweight, have emotional problems or have difficulty with English, there's a good chance your doctor could be ...
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(CNN) -- If you are overweight, have emotional problems or have difficulty with English, there's a good chance your doctor could be judging you because of it.

That troubling finding comes from a survey conducted over email of 15,800 physicians across the United States from more than 25 specialties, including emergency and family medicine and psychiatry. The survey was part of an annual report on bias and burnout among doctors that Medscape, a news and education resource for health care professionals, carries out every year.

The survey found that 40% of physicians reported having biases toward certain groups of patients. For a handful of specialties, closer to half of doctors said they harbored biases, including 62% of emergency medicine doctors, 50% of orthopedists, 48% of psychiatrists and 47% of family medicine doctors and OB-GYNs.

Biases were least common among radiologists, cardiologists and pathologists, of whom 22%, 22% and 10% respectively reported these feelings.

The most common reason that doctors said they stereotyped patients was because of their emotional problems, which elicited biases among 62% of physicians, followed by their weight, which 56% of male and 48% of female physicians said provoked biases for them. Other triggers were patients' intelligence, language differences, insurance coverage, age, income level, race and attractiveness.

Bias can influence the care patients get

"It's troubling, but not altogether unexpected," said Dr. Joseph R. Betancourt, director of the Disparities Solutions Center at Massachusetts General Hospital and Harvard Medical School. Betancourt was not involved in the survey.

A growing amount of research shows that doctors hold prejudices and that these prejudices can influence the kind of care that patients get. The Institute of Medicine and the National Academy of Sciences urged the need for more research on the issue in a 2003 report.

"I think 40% is probably an underestimation, because there is a component of subconscious bias," said Betancourt, who was one of the authors of the Institute of Medicine report. The current survey did not include tests, such as the implicit association test developed at Harvard, to determine whether doctors held biases that they were not even aware of.

"Human beings in general have these (subconscious) stereotypes, so it's hard to believe it couldn't be 80% or 90%," Betancourt said.

Betancourt also suspects that doctors in the survey might have been reluctant to admit prejudices that were less socially acceptable, such as biases toward racial groups. Only 16% of male and 14% of female physicians reported feeling biases toward patients based on race, but that is probably "exceedingly low compared to what the reality is," Betancourt said.

The 'not me' phenomenon

In the face of these findings, we could at least take some consolation in the fact that fewer than 15% of doctors, regardless of specialty, said that their biases affected the treatment they gave patients. But we probably shouldn't rest too easy.

"That (rate) is completely erroneous in my opinion, and built on the 'not me' phenomenon. Doctors say, 'I don't do it, not me,'" Betancourt said. "Doctors have been trained to believe that we make decisions based on symptoms and science and that personal characteristics don't impact us," he added.