Some medical students still think black patients feel less pain than whites

Black patients are systematically undertreated for pain, decades of research have shown. And a study published Monday sheds light on one factor that might contribute to this disparity.

In a survey of 222 white medical students and residents, about half endorsed false beliefs about biological differences between blacks and whites. And those who did also perceived blacks as feeling less pain than whites, and were more likely to suggest inappropriate medical treatment for black patients, according to the paper published in the Proceedings of the National Academy of Sciences.

First author Kelly Hoffman, a sixth-year PhD candidate in psychology at the University of Virginia, said that to her knowledge, this is the first study that connects racial bias about biology, racial perception of pain, and the accuracy of medical advice.

The overall survey included 100 laypeople and over 400 medical students and residents of different racial groups, asking them what they thought about statements like “Black people’s nerve endings are less sensitive than white people’s nerve endings” (which the authors say is false) and “Whites are less likely to have a stroke than blacks” (which the authors say is true). They also asked participants to imagine how much pain white or black individuals would experience in situations like getting their hand slammed in a car door. Researchers also asked medical students to suggest treatment for the patients. Then they looked at the relationship between those three categories.

There were many false beliefs espoused all around. But for white respondents specifically, those false beliefs correlated with their belief that blacks feel less pain, on average. What’s more, those medical students and residents with a higher than average level of false beliefs gave less accurate advice 15 percent of the time.

For non-white medical students and residents, false beliefs didn’t correlate with their perception of pain or the accuracy of their treatment recommendations.

Dr. David Satin, an assistant professor at the University of Minnesota Medical School who directs courses on topics of race, said that this study underscores the importance of teaching medical students to think critically about race and to understand how implicit bias impacts care.

Satin said he was disturbed by how many medical students and residents agreed with some of the false beliefs, such as the belief that blacks age more slowly than whites, with which 28 percent of surveyed second-year medical students agreed.

“If you’re really dedicated to science, that makes no sense,” Satin said. “Even if race is biological, that makes no sense. I’m disturbed by the fact that so many people endorse that.”

“This particular area is one of the most consequential in medicine,” said Lundy Braun, a professor of medical science and Africana studies at Brown University. “I hope that it helps to unsettle and change the scandalous undertreatment of blacks for pain.”

A study published last year found that black children were less likely than whites to receive pain medication in the emergency room while being treated for appendicitis. Two years ago, a study found that black veterans were less likely to be prescribed opioids than were whites for moderate or high levels of pain.

Because this study was a constructed experiment, and did not examine real medical interactions, Hoffman did not want to discuss the clinical significance of the findings. The study also examined correlation, but not causation.

Hoffman is collaborating with four medical schools to study whether educating students differently may reduce racial bias both in pain perception and treatment accuracy.