HLS Event Opens Dialogue on Role of Race in HealthcareKimani Paul-Emile in The Harvard Crimson, September 18, 2013
While the influence of racial bias on patients choosing healthcare providers might be socially problematic, a number of healthcare providers at Harvard Law School Tuesday afternoon asserted that respecting such personal preferences could nevertheless be the key to improving medical care.
Over brown-bag lunches, law students and faculty discussed the widely practiced phenomenon of allowing patients to choose their own doctors and nurses based on race. Associate Professor of Law at Fordham Law School Kimani Paul-Emile led the conversation by discussing her article “Patients’ Racial Preferences and the Medical Culture of Accommodation,” published in the UCLA Law Review.
While discrimination against patients has never been accepted in the medical profession, patient discrimination against doctors has often passed uncriticized. Some doctors, Paul-Emile explained, have an ethical obligation to ignore patient discrimination as secondary to providing proper medical care. Others, afraid of legal ramifications, are willing to allow patients to choose other doctors if they so desire.
Although Paul-Emile acknowledged that rejecting doctors based on race is “deeply troubling,” she also shared findings from her own research suggesting that racial concordance—when the physician and patient both identify as the same race—can actually enhance medical care.
“It seems that physician-patient race concordance confers significant health benefits for the patient, including more participatory decision-making and more patient trust,” she said. “Respecting patients’ requests for physicians may in fact be the key to improving care.”
Fidencio Saldana, instructor of medicine at Harvard Medical School, agreed that patients’ personal preferences were critical to effective care but suggested that these preferences did not always map over racial bias. He asked a few law students and faculty what it took to be a good doctor, and received responses ranging from “skill” to “trust and efficacy.” Neglecting any of these preferred traits, Saldana said, could break down a crucial relationship between physician and patient.
Renee M. Landers, professor of law at Suffolk Law School, suggested that maximizing diversity at medical schools could be one way to avoid racial bias in patient preferences.
“Numbers don’t tell the whole story of who should be in the medical profession,” she explained, pointing to a 21 percent gap between minorities in medical schools and minorities in the population.
“Diversity is a real means to achieve a core medical outcome,” she said.
Paul-Emile agreed that patients might be more likely to trust their physicians—regardless of race—if doctors were more open and diverse. “A long-term means of addressing this is by expanding cultural awareness among physicians, a means of encouraging tolerance and understanding among healthcare providers,” she said.