Disparities/Minority Health

Physicians' implicit racial attitudes influence prescribing of opioids for black children

Asthma, attention deficit hyperactivity disorder (ADHD), urinary tract infection, and pain are common conditions that children are routinely treated for by pediatricians. A new study suggests that physicians' implicit racial attitudes may influence their prescribing of opioids for black children. To examine the association between pediatricians' attitudes about race and their treatment recommendations, a research team from the University of Washington conducted an online survey of 86 pediatricians at a large urban research university. They looked at the association between implicit attitudes and stereotypes about race with recommendations for pain management, urinary tract infections, ADHD, and asthma, measured by case vignettes.
The only significant correlation found was between recommendations for pain management and implicit measures of racial bias. Physicians with stronger pro-white bias were more ready to prescribe opioid pain medication (the appropriate treatment option for the scenario) to white children than to black children.
Pain management was selected to be one of the case vignettes because this is an area with reported disparities, a high level of clinical subjectivity, and reports of clinicians' perceptions of blacks misusing opioids. The survey incorporated case vignettes using scenarios that pediatricians would likely encounter in their own clinical practice, and questions about explicit attitudes and stereotypes. It also included the Implicit Association Test, a timed cognitive test used to measure the relative strength between positive and negative associations toward one social group compared with another. The researchers call for more studies to understand the influence of physicians' unconscious beliefs about race on pain management and other areas of care. This study was supported in part by the Agency for Healthcare Research and Quality (HS15760).
See "The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma," by Janice A. Sabin, Ph.D., and Anthony G. Greenwald, Ph.D., in the May 2012 American Journal of Public Health 102(5), pp. 988-995.

— MWS