Doctors’ textbooks lack diversity, minorities at risk for lower-quality care: study

“What we found is that the representation of race in these medical textbooks is proportional to the population, but the representation of skin tone is not,” said University of Toronto PhD student Patricia Louie, the study’s lead author.

Louie explained that if doctors aren’t able to recognize certain diseases in particular racial groups, it could lead to the lower-quality care for patients with darker skin tones.

“If doctors associate certain skin tones with a particular racial group — for example, if doctors read a skin tone as a light patient, this might result in marginalization of patients with darker skin tones or racial minorities,” Louie said.

Teams from U of T and UBC collaborated to produce the study, which was published in the journal Social Science and Medicine.

To produce the findings, the group analyzed the race and skin tone of more than 4,000 human images in four medical textbooks: Atlas of Human Anatomy, Bates’ Guide to Physical Examination & History Taking, Clinically Oriented Anatomy and Gray’s Anatomy for Students.

They found that proportion of dark skin tones represented in all four books was was small. In Atlas, for example, less than one per cent of images featured dark-skinned subjects, compared to about eight per cent in Bates’, about one per cent in Clinically, and about five per cent in Gray’s.

Over 70 per cent of the images in Clinically and 88 per cent of those in Gray’s depicted people with light skin tones, while Atlas featured almost no skin tone diversity whatsoever.

The researchers went on to point out that some cancers, such as breast, cervical, colon, lung and skin cancer, are higher than average for African-American people due to late diagnoses.

“Because students don’t see how skin cancer presents itself on darker-skinned people, they might not be prepared to recognize skin cancer on [such] patients, and this could lead to inequities in medical treatment,” Louie said.

She explained that it’s imperative that doctors are trained to treat the bodies of all patients, and that medical school curriculum plays a large role in ensuring equal treatment.

UBC sociology professor and study co-author Rima Wilkes agreed, saying in a statement that the findings highlight a need for greater diversity in the teaching tools used by medical schools.

“Physicians are required to recognize diseases in patients with a variety of different skin tones,” Wilkes said. “When light-skin-toned bodies are shown as the norm, physicians might miss signs on patients with dark skin tone because they do not know how these abnormalities will present,” she said.

Several American studies on health care inequities point to biased care in medical practice, including racial bias in pain assessment and treatment; late-stage diagnosis of melanoma for dark-skinned patients versus light-skinned patients; and disproportionately low documentation of family breast cancer history for African-American women compared to white women.

A study published in June 2006 by the journal JAMA Dermatology found that of 1690 melanoma cases reported between 1997 and 2002, late-stage diagnosis was more common among Hispanic and non-Hispanic black patients  compared with non-Hispanic white patients.

The study concluded that the rates of advanced-stage diagnosis among Hispanic and black patients suggests sub-par prevention efforts in minority populations.

A second study published in 2016 by the National Academy of Scientists revealed that a significant number of medical students hold false beliefs about biological differences between black and white patients.

The study concluded that this can produce racial bias in pain perception among black patients, which can lead to bias in pain treatment recommendations.

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