What If Perceived Discrimination in Medicine Isn’t the Same as Real Discrimination?

Abstract

Given the fallibility of human perception, it ought to be uncontroversial that reality is not necessarily as we perceive it. However, the medical literature waives this elementary principle in one instance – that of discrimination perceived by minority patients. Judging the perception of discrimination in such cases as equal to discrimination per se, the literature maintains that black patients in particular accurately discern the same insidious bias in medicine that permeates a society that no longer tolerates overt racism. In reality, however, the supposed signals of implicit bias in the clinical encounter are too ambiguous, too uninterpretable, and too conflicting to be discerned with any certainty by anyone. What is clear is that if the perception of bias can lead patients to forgo treatment, so can the misperception of bias. Literature that assumes that medicine is polluted with concealed bias validates misperceptions, foments mistrust, and sends the incautious message that black patients can expect poor treatment.