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Difference in Pain Assessment: Implicit Biases in the Medical Field

“Nowadays, biological racism has become less socially acceptable. It has largely been replaced by implicit bias”; according to Ontario Health Coalition.

Racism, then and now, has changed. But consequences remain as crucial, they have just simply taken on a different form. Through the guise of modernity, we may not always clearly see the very subtle but yet, very present injustices racialized groups are facing. One of the many ongoing issues caused by this lack of awareness is the systematic racism pervasive in the medical field, which has a negative impact on practitioners’ pain assessment process, that has been proven to differ in relation to their patient’s ethnicity. These types of biases need to be addressed and dismantled without further delay. Otherwise, will mental and physical health ever be accessible equally and without prejudice to all?

According to an article by the Association of American Medical Colleges, it is stated that half of white medical trainees believe myths such as “black people have thicker skin or less sensitive nerve endings than white people”. These beliefs are not “long-forgotten 19th-century relics” as they have been recently published in 2016. What this means is that for years, white practitioners have been less likely to treat the pain of black people properly. The consequences of this leftover mentality can be found in many more research.

Another source revealed that “black patients were 22 percent less likely than white patients to receive any pain medication” and that “people living with mental health conditions are turned away or offered culturally unsafe healthcare, leading to increased rates of suicide and suffering”. Sadly, black, Indigenous and people of color (BIPOC) are seen as “drug seekers” and exaggerators in many cases. These negative experiences can later on be the cause of many anxieties and triggers racialized people face. In other cases, some individuals assume that their needs are not going to be met nor taken seriously and are thus less likely to reach out for help. These disparities then create a serious threat to the safety and overall wellness of multiple communities.

Moreover, Christopher Ervin, an advisor to the Black Women’s Health Imperative advocacy group, recognizes that many cultures may not always be very demonstrative or vocal about expressing pain and may not explicitly say it. That is often due to a different set of taboos found in the culture of some communities. The pain assessment is then solely up to the practitioner’s discretion… In addition, some clinicians assume that black people are more likely to be addicts. Therefore, they are less likely to be prescribed pain killers. The tragic irony here is that, according to The New York Times, white people are overprescribed painkillers such as opioids, and they are more likely to become addicted or overdose from fatal prescriptions.

As a result, this imbedded inequality creates a huge health disparity and perpetuates inadequate treatment of pain for many patients. Consequently, access to mental and physical health resources are not the same for different groups due to race and ethnicity. This shows us that white practitioners do not have the same empathy and concern for BIPOC patients as they do for white patients, even if it is mindlessly assessed. We need to address these subtle yet powerful implicit biases to even hope for a change among white practitioners.

People have this widespread notion that racism is only for bad people, but they tend to overlook the fact that good people can be racist as well. You are not bad for having a racist thought, you are simply wrong and misinformed by your environment. But you could take on the role of the bad guy by refusing to educate yourself on the matter and inflicting misconceptions onto others. Many individuals in the medical field are unaware of those implicit biases, which is precisely why there needs to be some light shed onto these conversations.

Implicit bias is dangerous and life-threatening when it is coming from a professional responsible for our health and wellbeing. A study concluded that “higher depression severity was associated with more antidepressant use for whites, but not blacks”. The American Psychological Association conducted in November 2017 that 16.5 percent of white Americans are taking antidepressants, and it is about three times as much as any other race or ethnic group. Compared to 5.6 percent of black Americans that took antidepressants in that same month, a disparity is not only alarming, but it needs immediate attention and action.

Here are some insightful books by incredible authors discussing the race and health gap, and how exactly these health disparities have been going on over the years and why:

“Being black can be bad for your health” – Damon tweedy

“Implicit bias is the single most important determinant of health and health care disparities” - Dayna Bowen Matthew

“… in an age of political correctness, most people will do almost anything to preserve the comfortable illusion of themselves as free of prejudice” – John Hoberman

It is absolutely crucial for us to breach that wall. We need to identify these implicit biases because this can lead towards legislative reforms, educational programs, and assessments with no individual discretion using specific guidelines.

We are all able to have a small yet meaningful impact by signing petitions and unlearning past misconceptions we or others may hold. All while balancing our emotional toll to avoid compassion fatigue. Acknowledging what is happening around us, putting things in different perspectives, and knowing we can contribute to change can bring a little peace of mind to many of us.

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