Physician bias: does it occur at teaching hospitals that serve a majority of African American patients?

The purpose of this study was to examine physician bias when patients present with cardiovascular disease in a teaching hospital that treats a majority of African American patients. Physician bias was deemed to occur when cardiovascular disease patients did not receive an invasive procedure when needed.

The hospital in the study was a teaching facility in southeastern Louisiana. We conducted a longitudinal retrospective review of 177 medical records from patients with cardiovascular disease. Patient charts were examined using specific indicators (type of pain, lab work, blood pressure, and x-ray tests) from the Framingham study (1996) to determine whether patients met the criteria for eligibility of invasive procedures, such as percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG) and if so, whether they were referred accordingly. Next, these charts were used to obtain confounders (race, sex, income, age, disease severity, and diagnoses) from each patient. Finally, a logistic regression analysis was used to determine the effect of these confounders on a patient being referred by a physician.

The model failed to find a statistically significant disparity between physician referrals for African Americans and Caucasians when cardiovascular disease patients met specific criteria. Therefore, physician referral disparities did not exist among this study population. This occurred despite the fact that the study controlled for primary diagnoses, disease severity, age, income, sex, and race.

This research concludes that physicians' referral patterns for cardiac procedures were similar for both African Americans and Caucasians. Moreover, this research suggests that referral disparities may not exist at teaching hospitals that serve a majority of African American patients. Future studies should delve deeper into physician/patient interaction at these institutions to understand what they do to reduce disparities in the hope of implementing their methods at other hospitals.