Teaching doctors to spot bias in care

Critics question how Dr. Stephen Nelson, a white pediatric hematologist, can train colleagues about racial bias in clinical decisionmaking.

Born in Virginia, raised by parents who voted for George Wallace, and related to a man who hangs a portrait of Robert E. Lee in his dining room, Nelson can hardly speak to the plight of marginalized minority patients.

On the other hand, if a doctor with his roots can spot racism in medicine, anyone can.

"As a white guy, takes one to know one," he said.

Nelson, who treats mostly black children with sickle cell anemia, is leading webinars on racial bias this spring as part of a Minnesota Medical Association campaign to address health inequities.

Black Minnesotans are less likely to have health insurance, more likely to suffer chronic diseases such as diabetes, and more likely to die early, compared to white Minnesotans.

Poverty and segregation help explain those gaps, Nelson said, but so too do doctors' subtle biases, which can inhibit trusting relationships with patients.

A 2012 study of the ER at Children's Hospital in Minneapolis, where Nelson works, found children of color with broken bones arrived for care 10 hours later, on average, than white children. That is partly explained by the income disparity that discourages lower-income minorities from seeking care immediately.

But then once in the ER, children of color waited 19 minutes longer than white children for pain drugs, Nelson said.

"That is an eternity if it's you with a broken femur."

In Nelson's specialty, studies show that doctors are less likely to offer a pain-reducing chemotherapy agent to black adult sickle cell anemia patients because they are less likely to accept it. He recalled a time when he told a nurse not to ask, because he was sure a patient would refuse.