This article reviews the literature on racism in medicine in the United States and reflects on the persistent barriers to diminishing racial biases in the U.S. health care system. Espoused strategies for decreasing racial disparities and reducing racial biases among physicians are critiqued, and recommendations are offered. Those recommendations include increasing the number of minority students in medical school, using Xavier University in New Orleans, Louisiana, as the model for medical school preparation; revamping the teaching of cultural competence; ensuring the quality of non-clinical staff; and reducing the risk of burnout among medical providers.
WashingtonHA.Medical Apartheid: The Dark History of Medical Experimentation on Black Americans From Colonial Times to the Present.
New York, NY:
Doubleday, 2006.
7.
FarberD.Crack: Rock Cocaine, Street Capitalism, and the Decade of Greed.
Cambridge, MA:
Cambridge University Press; 2019. doi:10.1017/9781108349055
8.
LombardoPADorrPA.Eugenics, medical education, and the public health service: another perspective on the Tuskegee syphilis experiment. Bull Hist Med. 2006;
80:291–316.
9.
ScharffDPMathewsKJJacksonPHoffsuemmerJMartinEEdwardsD.More than Tuskegee: understanding mistrust about research participation. J Health Care Poor Underserv. 2010;
21(3):879–897. doi:10.1353/hpu.0.0323
10.
Bonilla-SilvaE.Racism Without Racists: Color-Blind Racism and the Persistence of Racial Inequality in America.
Lanham, MD:
Rowman & Littlefield; 2017.
11.
Bonilla-SilvaEEmrickD.Ch. 2, Racism without racists: killing me softly with color blindness. In: CRossatoRAllenMPruyn, eds. Reinventing Critical Pedagogy: Widening the Circle of Anti-Oppression Education.
Lanham, MD:
Rowman & Littlefield; 2006:21–34.
12.
MasseyGCScottMVDornbuschSM.Racism without racists: institutional racism in urban schools. Black Sch. 1975;
7(3):10–19. doi:10.1080/00064246.1975.11413782
13.
GlaserJSpencerKCharbonneauA.Racial bias and public policy. Policy Insights Behav Brain Sci. 2014;
1(1):88–94. doi:10.1177/2372732214550403
14.
WilliamsDRWyattR.Racial bias in health care and health challenges and opportunities.JAMA. 2015;
314(6):555–556.
15.
ObermeyerZPowersBVogeliCMullainathanS.Dissecting racial bias in an algorithm used to manage the health of populations. Science. 2019;
366(6464):447–453. doi:10.1126/science.aax2342
16.
HallRE.The ball curve: calculated racism and the stereotype of African American men.Black Stud. 2001;
32(1). 104–119.
17.
SmileyCJFakunleD.From “brute” to “thug:” the demonization and criminalization of unarmed Black male victims in America. J Hum Behav Soc Environ. 2016;
26(3–4):350–366. doi:10.1080/10911359.2015.1129256
HodgeSRBurdenJWRobinsonLEBennettRA.Theorizing on the stereotyping of black male student athletes. J Study Sports Athlet Educ. 2008;
2(2):203–226. doi:10.1179/ssa.2008.2.2.203
20.
HollingsheadNAMeintsSMMillerMMRobinsonMEHirshAT.A comparison of race-related pain stereotypes held by White and Black individuals. J Appl Soc Psychol. 2016;
46(12):718–723. doi:10.1111/jasp.12415
21.
TrawalterSHoffmanKMWaytzA.Racial bias in perceptions of others’ pain [published correction appears in PLoS One. 2016;11(3):e0152334].PLoS One. 2012;
7(11):e48546. doi:10.1371/journal.pone.0048546
22.
BurstonBWJonesDRoberson-SaundersP.Drug use and African Americans: myth versus reality. J Alcohol Drug Educ. 1995;
40(2):19–39.
23.
BrooksS.Hypersexualization and the dark body: race and inequality among Black and Latina women in the exotic dance industry. Sex Res Soc Policy. 2010;
7:70–80. doi:10.1007/s13178-010-0010-5
24.
RosenthalLLobelM.Stereotypes of Black American women related to sexuality and motherhood. Psychol Women Q. 2016;
40(3):414–427. doi:10.1177/0361684315627459
FriedmanL.Gregarious Saints: Self and Community in American Abolitionism, 1830–1870.
New York, NY:
Cambridge University Press; 1982:xi, 344.
27.
ShelvinKHRivadenevraRZimmermanC.Stereotype thereat in African-American children: the role of black identity and stereotype awareness.Revue Internationale de Psychologie Sociale. 2014;
27(3):175–204.
28.
JayaratneTEYbarraOSheldonJP, et al.
White Americans’ genetic lay theories of race differences and sexual orientation: their relationship with prejudice toward blacks, and gay men and lesbians. Group Process Intergroup Relat. 2006;
9(1):77–94. doi:10.1177/1368430206059863
29.
KwateNOThreadcraftS.Perceiving the Black female body: race and gender in police constructions of body weight. Race Soc Probl. 2015;
7(3):213–226. doi:10.1007/s12552-015-9152-7
30.
GabbidonSLGreeneHTYoungVD.African American Classics in Criminology & Criminal Justice.
Thousand Oaks, CA:
Sage; 2002.
KhoslaNNPerrySPMoss-RacusinCABurkeSEDovidioJF.A comparison of clinicians’ racial biases in the United States and France. Soc Sci Med. 2018;
206:31–37. doi:10.1016/j.socscimed.2018.03.044
33.
WassermanD.Is racial profiling more benign in medicine than law enforcement?J Ethic. 2011;
15:119–129. doi:10.1007/s10892-010-9100-0
34.
MoskowitzGBStoneJChildsA.Implicit stereotyping and medical decisions: unconscious stereotype activation in practitioners’ thoughts about African-Americans. Am J Public Health. 2012;
102(5):996–1001.
BulginDTanabePJeneretteC.Stigma of sickle cell disease: a systematic review. Issues Mental Health Nurs. 2018;
39(8):675–686. doi:10.1080/01612840.2018.1443530
37.
ChibnallJTTaitRCAndresenEMHadlerNM.Race differences in diagnosis and surgery for occupational low back injuries.Spine (Phila Pa 1976). 2006;
31(11):1272–1275. doi:10.1097/01.brs.0000217584.79528.9b
38.
McGuireTGMirandaJ.New evidence regarding racial and ethnic disparities in mental health: policy implications. Health Aff (Millwood). 2008;
27(2):393–403. doi:10.1377/hlthaff.27.2.393
39.
SahaSFreemanMToureJTippensKMWeeksCIbrahimS.Racial and ethnic disparities in the VA health care system: a systematic review. J Gen Intern Med. 2008;
23(5):654–671. doi:10.1007/s11606-008-0521-4
40.
CampbellLJCaiXGaoSLiY.Racial/ethnic disparities in nursing home quality of life deficiencies, 2001 to 2011. Gerontol Geriatr Med. 2016;
2:2333721416653561. doi:10.1177/2333721416653561
41.
LefebvreKMLaveryLA.Disparities in amputations in minorities. Clin Orthop Relat Res. 2011;
469(7):1941–1950. doi:10.1007/s11999-011-1842-x
42.
CargillVAStoneVE.HIV/AIDS: a minority health issue. Med Clin North Am. 2005;
89(4):895–912. doi:10.1016/j.mcna.2005.03.005
43.
BreathettKLiuWGAllenLA, et al.
African Americans are less likely to receive care by a cardiologist during an intensive care unit admission for heart failure.J Am Coll Cardiol Heart Fail. 2018;
6:413–20. doi:10.1016/j.jchf.2018.05.010
44.
TenoJMPlotzkeMChristianTGozaloP.Examining variation in hospice visits by professional staff in the last 2 days of life. JAMA Intern Med. 2016;
176(3):364–370. doi:10.1001/jamainternmed.2015.7479
45.
KulkarniSLadinKHaakinsonDGreeneELiLDengY.Association of racial disparities with access to kidney transplant after the implementation of the new kidney allocation system. JAMA Surg. 2019;
154(7):618–625. doi:10.1001/jamasurg.2019.0512
46.
BellCCJacksonWMBellBH.Misdiagnosis of African-Americans with psychiatric issues – part II. J Natl Med Assoc. 2015;
107(3):35–41. doi:10.1016/S0027-9684(15)30049-3
47.
MetzlJ.The Protest Psychosis: How Schizophrenia Became a Black Disease.
Boston, MA:
Beacon Press; 2011.
48.
PayneJS.Influence of race and symptom expression on clinicians’ depressive disorder identification in African American men. J Soc Soc Work Res. 2012;
3(3):162–177. doi:10.5243/jsswr.2012.11
49.
SchwartzRCBlankenshipDM.Racial disparities in psychotic disorder diagnosis: a review of empirical literature. World J Psychiatry. 2014;
4(4):133–140. doi:10.5498/wjp.v4.i4.133
50.
BeckerGNewsomE.Socioeconomic status and dissatisfaction with health care among chronically ill African Americans. Am J Public Health. 2003;
93(5):742–748. doi:10.2105/ajph.93.5.742
51.
FiscellaKFranksPGoldMRClancyCM.Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000;
283(19):2579–2584. doi:10.1001/jama.283.19.2579
52.
WelchLCTenoJMMorV.End-of-life care in black and white: race matters for medical care of dying patients and their families. J Am Geriatr Soc. 2005;
53(7):1145–1153. doi:10.1111/j.1532-5415.2005.53357.x
53.
ShahAAZoggCKZafarSN, et al.
Analgesic access for acute abdominal pain in the emergency department among racial/ethnic minority patients: a nationwide examination. Med Care. 2015;
53:1000–1009. doi:10.1097/MLR.0000000000000444
54.
GoyalMKKuppermannNClearySDTeachSJChamberlainJM.Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. 2015;
169(11):996–1002. doi:10.1001/jamapediatrics.2015.1915
PhelanSMBurkeSECunninghamBA, et al.
The effects of racism in medical education on students’ decisions to practice in underserved or minority communities.Acad Med. 2019;
94(8):1178–1189. doi:10.1097/ACM.0000000000002719
58.
VanderbiltAABaughRFHoguePABrennanJAAliII.Curricular integration of social medicine: a prospective for medical educators. Med Educ Online. 2016;
21:30586. doi:10.3402/meo.v21.30586
BraunL.Theorizing race and racism: preliminary reflections on the medical curriculum. Am J Law Med. 2017;
43(2–3):239–256. doi:10.1177/0098858817723662
61.
BraunLSaundersB.Avoiding racial essentialism in medical science curricula. AMA J Ethics. 2017;
19(6):518–527. doi:10.1001/journalofethics.2017.19.6.peer1-1706
62.
KaraniRVarpioLMayW, et al.
Commentary: racism and bias in health professions education: how educators, faculty developers, and researchers can make a difference. Acad Med. 2017;
92(11S): S1–S6. doi:10.1097/ACM.0000000000001928
63.
White-DavisT, et al.
Addressing racism in medical education: an interactive training module. Fam Med. 2018;
50(5):364–368. doi:10.22454/FamMed.2018.875510
64.
BakkeKSidharKKumagaiAK.Exploring matters of race through dialogue in the University of Michigan Medical School’s longitudinal case studies program. Virt Mentor AMA J Ethics. 2014;
16(6):442–449. doi:10.1001/virtualmentor.2014.16.6.medu1-1406
65.
WagnerRKohNBagianJPWeissKB, for the CLER Program. CLER 2016 National Report of Findings. Issue Brief #4: Health Care Disparities. Chicago, IL: Accreditation Council for Graduate Medical Education.
66.
CooperRS.Race in biological and biomedical research. Cold Spring Harb Perspect Med. 2013;
3(11):a008573. doi:10.1101/cshperspect.a008573
67.
GravleeCC.How race becomes biology: embodiment of social inequality. Am J Phys Anthropol. 2009;
139(1):47–57. doi:10.1002/ajpa.20983
CDC Tuskegee Timeline. US Public Health Service Syphilis Study at Tuskegee. CDC. https://www.cdc.gov/tuskegee/timeline.htm. Published 2015. Accessed February 5, 2020.
70.
DusterT.Buried alive: the concept of race in science. In: GoodmanAHHeathDSusan LindeeM, eds. Genetic Nature/Culture: Anthropology and Science Beyond the Two-Culture Divide.
Berkeley, CA:
University of California Press; 2003:258–277.
71.
MorningA.The Nature of Race: How Scientists Think and Teach about Human Difference. 1st ed. Berkeley, CA: University of California Press; 2011. www.jstor.org/stable/10.1525/j.ctt1pnrht. Accessed February 7, 2020.
72.
RichesonJASommersSR.Toward a social psychology of race and race relations for the twenty-first century. Ann Rev Psychol. 2016;
67:439–463. doi:10.1146/annurev-psych-010213-115115
73.
GravesJL.Great is their sin: biological determinism in the age of genomics. Ann Am Acad Polit Soc Sci. 2015;
661(1):24–50. doi:10.1177/0002716215586558
74.
JamiesonARadickG.Genetic determinism in the genetics curriculum. Sci Educ2017;
26:1261–1290. doi:10.1007/s11191-017-9900-8
75.
GerickeNCarverRCastéraJ, et al.
Exploring relationships among belief in genetic determinism, genetics knowledge, and social factors. Sci Educ. 2017;
26:1223–1259. doi:10.1007/s11191-017-9950-y
76.
KazoryA.Physicians, their appearance and the white coat. AJM. 2008;
121(9):825–828. doi:10.1016/j.amjmed.2008.05.030
77.
GlassJ.Is herd thinking in medical training leading us astray?BMJ. 2017;
358:j4297. doi:10.1136/bmj.j4297
78.
SaposnikGMaurinoJSempereAPRuffCCToblerPN.Herding: a new phenomenon affecting medical decision-making in multiple sclerosis care? Lessons learned from DIScUTIR MS. Patient Prefer Adher. 2017;
11:175–180. doi:10.2147/PPA.S124192
79.
TsaiJUcikLBaldwinNHasslingerCGeorgeP.Race matters? Examining and rethinking race portrayal in preclinical medical education.Acad Med. 2016;
91:916–920.
80.
LujanHLDiCarloSE.The “African gene” theory” It is time to stop teaching and promoting the slavery hypertension hypothesis. Adv Physiol Educ. 2018;
42:412–416. doi:10.1152/advan.00070.2018.
81.
TabatabaeiZYazdaniSSadeghiR.Barriers to integration of behavioral and social sciences in the general medicine curriculum and recommended strategies to overcome them: a systematic review. J Adv Med Educ Profess. 2016;
4(3):111–121. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927253/. Accessed November 20, 2019.
82.
WassermanJA.On art and science: an epistemic framework for integrating social science and clinical medicine. J Med Philos. 2014;39:279–303. doi:10.1093/jmp/jhu015
83.
MorningA.Reconstructing race in science and society: biology textbooks, 1952-2002. AJS. 2008;
114Suppl:S106–S137. doi:10.1086/592206
WilliamsDRSternthalM.Understanding racial-ethnic disparities in health: sociological contributions. J Health Soc Behav. 2010;
51Suppl(Suppl):S15–S27. doi:10.1177/0022146510383838
88.
PlautVCThomasKMHurdKRomanoCA.Do color blindness and multiculturalism remedy or foster discrimination and racism?Curr Dir Psychol Sci. 2018;
27(3):200–206. doi:10.1177/0963721418766068
89.
ManningAHartmannDGerteisJ.Colorblindness in Black and White: an analysis of core tenets, configurations, and complexities.Soc Race Ethn. 2015;
1(4):532–546. doi:10.1177/2332649215584828
90.
Bonilla-SilvaEBaiocchiG.Anything but racism: how sociologists limit the significance of racism. Race Soc. 2001;
4(2):117–131. doi:10.1016/S1090-9524(03)00004-4
91.
QuirozP.Adoption in a Color-Blind Society.
Plymouth, England:
Rowman & Littlefield; 2007.
CunninghamBAScarlatoASM.Ensnared by colorblindness: discourse on health care disparities. Ethn Dis. 2018;
28(Suppl 1):235–240. doi:10.18865/ed.28.S1.235
94.
GoffPASteeleCMDaviesPG.The space between us: stereotype threat and distance in interracial contexts. J Pers Soc Psychol. 2008;
94(1):91–107. doi:10.1037/0022-3514.94.1.91
ParadiesYPriestNBenJ, et al.
Racism as a determinant of health: a protocol for conducting a systematic review and meta-analysis. Syst Rev2013;
2:85. doi:10.1186/2046-4053-2-85
97.
ParadiesYBenJDensonN, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015:
10(9):e0138511.
AbdouCMFingerhutAW.Stereotype threat among black and white women in health care settings.Cult Divers Ethn Minor Psychol. 2014;
20(3):316–323. doi:10.1037/a0036946
100.
AronsonJBurgessDPhelanSMJuarezL.Unhealthy interactions: the role of stereotype threat in health disparities. Am J Public Health. 2013;
103(1):50–56. doi:10.2105/AJPH.2012.300828
101.
TomyczND.A profession selling out: lamenting the paradigm shift in physician advertising. J Med Ethics. 2006;
32(1):26–28. doi:10.1136/jme.2005.012617
102.
MarlowAE.The professional decline of physicians in the era of managed care. N Engl J Public Policy. 1997;
13(2):Article 8. http://scholarworks.umb.edu/nejpp/vol13/iss2/8. Accessed January 30, 2020.
BakerR.The American Medical Association and Race. history of medicine. AMA J Ethics. 2014;
16(6):479–488. doi:10.1001/virtualmentor.2014.16.6.mhst1-1406.
FordtranJSPrinceRSeldinDW.A Dallas doctor who spoke truth to power: three perspectives. Proc (Bayl Univ Med Cent). 2012;
25(3):254–264. doi:10.1080/08998280.2012.11928844
107.
KriegerN.Stormy weather: race, gene expression, and the science of health disparities. Am J Public Health. 2005;
95(12):2155–2160. doi:10.2105/AJPH.2005.067108
108.
DehonEWeissNJonesJFaulconerWHintonESterlingS.A systematic review of the impact of physician implicit racial bias on clinical decision making. Acad Emerg Med. 2017;
24(8):895–904. doi:10.1111/acem.13214
109.
JohnsonTJWingerDGHickeyRW, et al.
Comparison of physician implicit racial bias toward adults versus children. Acad Pediatr. 2017;
17(2):120–126. doi:10.1016/j.acap.2016.08.010
110.
FitzGeraldCHurstS.Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;
18:19. doi:10.1186/s12910-017-0179-8
HausmannLRMyaskovskyLNiyonkuruC, et al.
Examining implicit bias of physicians who care for individuals with spinal cord injury: a pilot study and future directions. J Spinal Cord Med. 2015;
38(1):102–110. doi:10.1179/2045772313Y.0000000184
113.
OliverMNWellsKMJoy-GabaJAHawkinsCBNosekBA.Do physicians’ implicit views of African Americans affect clinical decision making? J Am Board Fam Med. 2014;
27(2):177–188. doi:10.3122/jabfm.2014.02.120314
114.
SabinJNosekBAGreenwaldARivaraFP.Physicians’ implicit and explicit attitudes about race by MD race, ethnicity, and gender. J Health Care Poor Underserv. 2009;
20(3):896–913. doi:10.1353/hpu.0.0185
115.
van RynMBurkeJ.The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000;
50(6):813–828. doi:10.1016/s0277-9536(99)00338-x
116.
GreenARCarneyDRPallinDJ, et al.
Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;
22(9):1231–1238. doi:10.1007/s11606-007-0258-5
117.
PlaisimeMVMalebrancheDJDavisAL, et al.
Healthcare providers’ formative experiences with race and black male patients in urban hospital environments. J Racial Ethn Health Dispar. 2017;
4:1120–1127. doi:10.1007/s40615-016-0317-x
118.
HallWJChapmanMVLeeKM, et al.
Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;
105(12):e60–e76. doi:10.2105/AJPH.2015.302903
119.
ChapmanENKaatzACarnesM.Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;
28(11):1504–1510. doi:10.1007/s11606-013-2441-1
HaiderAHSchneiderEBSriramN, et al.
Unconscious race and social class bias among acute care surgical clinicians and clinical treatment decisions. JAMA Surg. 2015;
150(5):457–464. doi:10.1001/jamasurg.2014.4038
122.
SabinJAGreenwaldAG.The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. Am J Public Health. 2012;
102(5):988–995. doi:10.2105/AJPH.2011.300621
123.
ShaversVLFaganPJonesDA, et al.
The state of research on racial/ethnic discrimination in the receipt of health care. Am J Public Health. 2012;
102(5):953–966. doi:10.2105/AJPH.2012.300773
124.
MainaIWBeltonTDGinzbergSSinghAJohnsonTJ.A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Soc Sci Med. 2018;
199:219–229. doi:10.1016/j.socscimed.2017.05.009.
125.
FreshmanB.Cultural competency – best intentions are not good enough.Divers Equal Health Care. 2016;
13(3):240–244.
126.
ScheidTLSmithGH.Is physician-patient concordance associated with greater trust for women of low socioeconomic status?Women Health. 2017;
57(6):631–649. doi:10.1080/03630242.2016.1202881
127.
MartinBCShiLWardRD.Race, gender, and language concordance in the primary care setting. Int J Health Care Qual Assur. 2009;
22(4):340–352. doi:10.1108/09526860910964816
128.
MeghaniSHByunEGallagherRM.Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States. Pain Med. 2012;
13(2):150–174. doi:10.1111/j.1526-4637.2011.01310.x
129.
AlsanMGarrickOGrazianiG.Does Diversity Matter for Health? Experimental Evidence from Oakland. NBER Working Paper No. 24787. NBER Program(s): Health Economics Program. https://www.nber.org/papers/w24787. Published 2018. Revised 2019. Accessed January 5, 2020.
130.
HillAJonesDWoodworthL. A doctor like me: physician-patient race-match and patient outcomes. SSRN. July 9, 2018. http://doi.org/10.2139/ssrn.3211276. Accessed July 30, 2019.
131.
Cooper-PatrickLGalloJJGonzalesJJ, et al.
Race, gender, and partnership in the patient-physician relationship. JAMA. 1999;
282(6):583–589. doi:10.1001/jama.282.6.583
132.
SahaSKomaromyMKoepsellTDBindmanAB.Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;
159(9):997–1004. doi:10.1001/archinte.159.9.997
133.
ZhaoCDowzickyPColbertLRobertsSKelzRR.Race, gender, and language concordance in the care of surgical patients: a systematic review. Surgery. 2019;
166(5):785–792. doi:10.1016/j.surg.2019.06.012
BarrDAWanatSF.Listening to patients: cultural and linguistic barriers to health care access.Fam Med. 2005;
37(3):199–204.
138.
MarrastLMZallmanLWoolhandlerSBorDHMcCormickD.Minority physicians’ role in the care of underserved patients: diversifying the physician workforce may be key in addressing health disparities. JAMA Intern Med. 2014;
174(2):289–291. doi:10.1001/jamainternmed.2013.12756
139.
CooperLARoterDL. Patient-provider communication: the effect of race and ethnicity on process and outcomes of healthcare. In: Smedley BD, Stith AY, Nelson AR, eds. Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003. https://www.ncbi.nlm.nih.gov/books/NBK220354/. Accessed February 8, 2020.
140.
DensonN.Do curricular and cocurricular diversity activities influence racial bias? A meta-analysis. Rev Educ Res. 2009;
79(2):805–838. doi:10.3102/0034654309331551
141.
van RynMHardemanRPhelanSM, et al.
Medical school experiences associated with change in implicit racial bias among 3547 students: a medical student changes study report. J Gen Intern Med. 2015;
30(12):1748–1756. doi:10.1007/s11606-015-3447-7
142.
KingtonRTisnadoDCarlisleDM.Increasing racial and ethnic diversity among physicians: an intervention to address health disparities? National academy of sciences. In: NickensHWSmedleyBDStithAYColburnLEvansCH, eds. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions Summary of the Symposium on Diversity in Health Professions in Honor Herbert W. Nickens, MD.
Washington, DC:
National Academies Press; 2001.
143.
FeaginJBennefieldZ.Systemic racism and U.S. health care. Soc Sci Med. 2014;
103:7–14. doi:10.1016/j.socscimed.2013.09.006
144.
KahnKBDaviesPG.Differentially dangerous? Phenotypic racial stereotypicality increases implicit bias among ingroup and outgroup members. Group Process Intergroup Relat. 2011;
14(4):569–580. doi:10.1177/1368430210374609
145.
KirmayerLJ.Rethinking cultural competence. Transcult Psychiatry. 2012;
49(2):149–164. doi:10.1177/1363461512444673
146.
JongenCMcCalmanJBainbridgeR.Health workforce cultural competency interventions: a systematic scoping review. BMC Health Serv Res. 2018;
18(1):232. doi:10.1186/s12913-018-3001-5
147.
JerniganVBHearodJBTranKNorrisKCBuchwaldD.An examination of cultural competence training in US medical education guided by the tool for assessing cultural competence training. J Health Dispar Res Pract. 2016;
9(3):150–167.
148.
GovereLGovereEM.How effective is cultural competence training of healthcare providers on improving patient satisfaction of minority groups? A systematic review of literature. Worldviews Evid Based Nurs. 2016;
13(6):402–410. doi:10.1111/wvn.12176
149.
AlizadehSChavanM.Cultural competence dimensions and outcomes: a systematic review of the literature. Health Soc Care Community. 2016;
24(6):e117–e130. doi:10.1111/hsc.12293
150.
ForscherPSLaiCKAxtJR, et al.
A meta-analysis of procedures to change implicit measures. J Pers Soc Psychol. 2019;
117:522. doi:10.1037/pspa0000160
151.
FitzGeraldCMartinABernerD, et al.
Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: a systematic review. BMC Psychol. 2019;
7:29. doi:10.1186/s40359-019-0299-7
152.
PageKRCastillo-PageLWrightSM.Faculty diversity programs in U.S. medical schools and characteristics associated with higher faculty diversity.Acad Med. 2011;
86(10):1221–1228. doi:10.1097/ACM.0b013e31822c066d
BachPBPhamHHSchragDTateRCHargravesJL.Primary care physicians who treat blacks and whites. N Engl J Med. 2004;
351(6):575–584. doi:10.1056/NEJMsa040609
156.
GarcesLMMickey-PabelloD.Racial diversity in the medical profession: the impact of affirmative action bans on underrepresented student of color matriculation in medical schools. J Higher Educ. 2015;
86(2):264–294. doi:10.1353/jhe.2015.0009
SwartzSArogundadeEDavisD.Unpacking (white) privilege in a South African university classroom: a neglected element in multicultural educational contexts. J Moral Educ. 2014;
43(3):345–361. doi:10.1080/03057240.2014.922942
160.
AlexisCWhiteAThomasCPoweskiJ.Unpacking reactions to white privilege among employees of an academic medical center. J Cult Divers. 2019;
26(1):28–37. doi:10.1080/23311886.2015.1053183
161.
CintronAMorrisonRS.Pain and ethnicity in the United States: a systematic review. J Palliat Med. 2006;
9(6):1454–1473. doi:10.1089/jpm.2006.9.1454
SantoroTNSantoroJD.Racial bias in the US opioid epidemic: a review of the history of systemic bias and implications for care. Cureus. 2018;
10(12):e3733. doi:10.7759/cureus.3733
165.
AssariSMoazen-ZadehECaldwellCHZimmermanMA.Racial discrimination during adolescence predicts mental health deterioration in adulthood: gender differences among blacks. Front Public Health. 2017;
5:104. doi:10.3389/fpubh.2017.00104
166.
LewisTTCogburnCDWilliamsDR.Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol. 2015;
11:407–440. doi:10.1146/annurev-clinpsy-032814-112728
167.
TrentMDooleyDGDougéJ.The impact of racism on child and adolescent health.Pediatrics. 2019;
144(2):e20191765. doi:10.1542/peds.2019-1765
168.
WilliamsDRLawrenceJADavisBA.Racism and health: evidence and needed research. Annu Rev Public Health. 2019;
40:105–125. doi:10.1146/annurev-publhealth-040218-043750
169.
BrondoloELoveEEPencilleMSchoenthalerAOgedegbeG.Racism and hypertension: a review of the empirical evidence and implications for clinical practice. Am J Hypertens. 2011;
24(5):518–529. doi:10.1038/ajh.2011.9
170.
QuinlanJPearsonLNClukayCJ, et al.
Genetic loci and novel discrimination measures associated with blood pressure variation in African Americans living in Tallahassee. PLoS One. 2016;
11(12): e0167700. doi:10.1371/journal.pone.0167700
171.
ThamesADIrwinMRBreenECColeSW.Experienced discrimination and racial differences in leukocyte gene expression [published correction appears in Psychoneuroendocrinology. 2019 Nov;109:104422].Psychoneuroendocrinology. 2019;
106:277–283. doi:10.1016/j.psyneuen.2019.04.016
172.
McGeeEOStovallD.Reimagining critical race theory in education: mental health, healing, and the pathway to liberatory praxis. Educ Theory. 2015;
65:491–511. doi:10.1111/edth.12129
OlfsonMCherryDKLewis-FernándezR.Racial differences in visit duration of outpatient psychiatric visits. Arch Gen Psychiatry. 2009;
66(2):214–221. doi:10.1001/archgenpsychiatry.2008.523
176.
PennerLADovidioJFGonzalezR, et al.
The effects of oncologist implicit racial bias in racially discordant oncology interactions. J Clin Oncol. 2016;
34(24):2874–2880. doi:10.1200/JCO.2015.66.3658
177.
StepanikovaI.Racial-ethnic biases, time pressure, and medical decisions. J Health Soc Behav. 2012;
53(3):329–343. doi:10.1177/0022146512445807
178.
AshtonCMHaidetPPaternitiDA, et al.
Racial and ethnic disparities in the use of health services: bias, preferences, or poor communication?J Gen Intern Med. 2003;
18(2):146–152. doi:10.1046/j.1525-1497.2003.20532.x
179.
ElliottAMAlexanderSCMescherCAMohanDBarnatoAE.Differences in physicians’ verbal and nonverbal communication with black and white patients at the end of life. J Pain Symptom Manage. 2016;
51(1):1–8. doi:10.1016/j.jpainsymman.2015.07.008
180.
BeachMCSahaSKorthuisPT, et al.
Patient-provider communication differs for black compared to white HIV-infected patients. AIDS Behav. 2011;
15(4):805–811. doi:10.1007/s10461-009-9664-5
181.
CooperLRoterDCarsonK, et al.
The association of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;
102:979–987. doi:10.2105/AJPH.2011.300558
182.
JohnsonRLRoterDPoweNRCooperLA.Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health. 2004;
94(12):2084–2090. doi:10.2105/ajph.94.12.2084
183.
HagiwaraNSlatcherRBEgglySPennerLA.Physician racial bias and word use during racially discordant medical interactions. Health Commun. 2017;
32(4):401–408. doi:10.1080/10410236.2016.1138389
TealCRStreetRL.Critical elements of culturally competent communication in the medical encounter: a review and model. Soc Sci Med. 2009;
68(3):533–543. doi:10.1016/j.socscimed.2008.10.015
186.
MartinKDRoterDLBeachMCCarsonKACooperLA.Physician communication behaviors and trust among black and white patients with hypertension. Med Care. 2013;
51(2):151–157. doi:10.1097/MLR.0b013e31827632a2
187.
ParkJBanajiMR.Mood and heuristics: the influence of happy and sad states on sensitivity and bias in stereotyping. J Pers Soc Psychol. 2000;
78(6):1005–1023. doi:10.1037/0022-3514.78.6.1005
188.
FabbroACrescentiniCMatizAClariciAFabbroF.Effects of mindfulness meditation on conscious and non-conscious components of the mind. Appl Sci. 2017;
7:349. doi:10.3390/app7040349
JohnsonKJFredricksonBL.“We all look the same to me”: positive emotions eliminate the own-race bias in face recognition. Psychol Sci. 2005;
16(11):875–881. doi:10.1111/j.1467-9280.2005.01631.x
191.
HassNCLimSL.Negative mood impacts the relationship between explicit and implicit age-related attitudes. North Am J Psychol. 2017;
19:339–358.
BurgessDvan RynMDovidioJSahaS.Reducing racial bias among health care providers: lessons from social-cognitive psychology. J Gen Intern Med. 2007;
22(6):882–887. doi:10.1007/s11606-007-0160-1
196.
EdwardsDJMcEnteggartCBarnes-HolmesYLoweREvansNVilardagaR.The impact of mindfulness and perspective-taking on implicit associations toward the elderly: a relational frame theory account.Mindfulness (NY). 2017;
8(6):1615–1622. doi:10.1007/s12671-017-0734-x
197.
StoneJMoskowitzGB.Non-conscious bias in medical decision making: what can be done to reduce it? Med Educ. 2011;
45(8):768–776. doi:10.1111/j.1365-2923.2011.04026.x
198.
DyrbyeLHerrinJWestCP, et al.
Association of racial bias with burnout among resident physicians. JAMA Netw Open. 2019;
2(7):e197457. doi:10.1001/jamanetworkopen.2019.7457
PhillipsD. Burnout and racial bias among residents: chicken or egg? Medscape Medical News. July 26, 2019. https://www.medscape.com/viewarticle/916106. Accessed February 9, 2020.
201.
BurgessDJBeachMCSahaS.Mindfulness practice: a promising approach to reducing the effects of clinician implicit bias on patients. Patient Educ Couns. 2017;
100(2):372–376. doi:10.1016/j.pec.2016.09.005
202.
KangYGrayJRDovidioJF.The nondiscriminating heart: lovingkindness meditation training decreases implicit intergroup bias. J Exp Psychol Gen. 2014;
143(3):1306–1313. doi:10.1037/a0034150
203.
LuekeAGibsonB.Mindfulness meditation reduces implicit age and race bias: the role of reduced automaticity of responding. Soc Psychol Pers Sci2015;
6(3):284–291. doi:10.1177/1948550614559651
204.
AthanasAJMcCorrisonJMSmalleyS, et al.
Association between improvement in baseline mood and long-term use of a mindfulness and meditation app: observational study.JMIR Mental Health. 2019;
6(5):e12617. doi:10.2196/12617
205.
SutcliffeKMVogusTJDaneD.Mindfulness in organizations: a cross-level review. Ann Rev Organ Psychol Organ Behav. 2016;
3(1):55–81. doi:10.1146/annurev-orgpsych-041015-062531
206.
TealCRGillACGreenARCrandallS.Helping medical learners recognise and manage unconscious bias toward certain patient groups. Med Educ. 2012;
46(1):80–88. doi:10.1111/j.1365-2923.2011.04101.x
207.
JacobsEARolleIFerransCEWhitakerEEWarneckeRB.Understanding African Americans’ views of the trustworthiness of physicians. J Gen Intern Med. 2006;
21(6):642–647. doi:10.1111/j.1525-1497.2006.00485.x
AndrewsNGreenfieldSDreverWRedwoodS.Strong, female and Black: stereotypes of African Caribbean women’s body shape and their effects on clinical encounters. Health. 2017:
21(2):189–204. doi:10.1177/1363459315595847
