Patients’ biases toward providers’ gender or race may affect how well their body reacts to medical treatments—even when their conscious minds aim to set those preconceptions aside, a new study suggests.
Published this week, the blinded investigation looked to expand upon the well-studied placebo effect, where the body reacts to inert treatment based on the mind’s belief of potential benefit, and how the social context of healthcare delivery can impact patient outcomes.
Researchers found that 187 white patients had different physiological responses to a placebo relief cream given shortly after an allergy skin prick test based on whether their provider was a man or woman, or was Asian, Black or white.
Specifically, the patients of female providers demonstrated stronger allergic reactions than those of male providers after the placebo cream was applied, according to the study. Patients of Black providers also had stronger allergic reactions compared to those with White and Asian providers, both immediately following the skin prick test and after they had received the placebo cream.
The kicker, researchers wrote, was that the reactions didn’t align with how the patients consciously reacted to their particular provider.
In gradings taken after their encounters, the patients rated female providers as warmer and more competent than male providers, as well as Black and Asian providers compared to white providers.
Additionally, researchers gauged whether patients demonstrated nonverbal evidence of implicit bias by showing short, silent clips of the patients during their interaction to more than 1,200 participants recruited via online crowdsourcing.
These viewers were asked to rate the clips based on whether the patient appeared to be uncomfortable and whether the patient appeared to dislike their doctor or the interaction.
The raters did not view the patients as showing nonverbal bias during interactions with Black or female providers and even rated their nonverbal reactions to female providers as more positive and more relaxed compared to male providers, according to the study.
Similar crowdsourced grading also found the patients to appear more socially engaged during their encounters with female providers or providers of color—potentially demonstrating “overcompensation to actively counter bias” by the study’s white patients.
“These results illustrate how notions of race and gender can influence patients beneath the surface—literally under the skin—despite their professed intentions and even to their own detriment,” the researchers wrote in the Proceedings of the National Academy of Sciences.
The findings are relevant due to the shifting makeup of the healthcare workforce, the researchers wrote. While white men are still the dominant demographic, the share of women and people of color entering medical school has risen in recent years.
The study’s findings suggest most patients subconsciously still associate healthcare professionals with certain demographics and that, “whether we want it to or not, our history of exposure leaves its trace,” researchers wrote.
Still, the team said it was surprised at finding similar patient placebo responses to Asian providers as white providers.
“It is as though Asian providers have already been absorbed into white patients’ notions of what a doctor looks like, whereas that absorption for Black doctors remains beyond reach,” they wrote. “Future studies in different regions of the country are needed to explore this possibility further.”
Because the placebo effect has been shown to have an impact on a broad array of medical contexts and treatments, the researchers advocated for further research examining a similar study design for different healthcare scenarios.
“For example, how might doctors’ race and gender influence patient adherence to prescribed medical regimes or to advice to schedule laboratory tests or follow-up with specialists?” they wrote. “Or, how might race and gender influence treatment effectiveness when a patient’s health concerns are highly personal (e.g., gynecology), when there is more contact between the provider and patient (e.g., primary care), and/or when the treatment is especially risky (e.g., neurosurgery)?”