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Why we all discriminate – even our doctors

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We sometimes imagine that discrimination is a blight confined to earlier times and far-away places. Unfortunately, discrimination — that is, treating people better or worse simply because they are members of a particular socially-defined group — occurs in every aspect of our lives today, from the workplace to the doctor’s office.

When researchers sent mock resumes in response to job postings in the Toronto area, a person with an English-sounding name such as "John Martin" was 40 per cent more likely to be offered an interview than a person with an ethnic-sounding name such as "Arjun Kumar," even when the two resumes listed exactly the same skills and qualifications.

Discrimination can occur on the basis of socioeconomic status as well as ethnicity. In a study that we recently published in the Canadian Medical Association Journal, researchers called doctors’ offices in Toronto while playing the role of a person looking for a family physician. Doctors’ offices were 58 per cent more likely to offer an appointment if the caller mentioned that he or she had a high-status job than if he or she mentioned receiving welfare.

Even within the Canadian system of universal health insurance, people with high socioeconomic status receive preferential access to health care.

Why is discrimination a serious problem? Of course, discrimination is an affront to our innate sense of justice. We aspire to live in a world where people are treated fairly, and not judged by the colour of their skin or the size of their wallet.

But another reason to oppose discrimination is that it diminishes a society’s overall performance and achievement. A society will ultimately be less successful if opportunities are made available to individuals on the basis of favouritism rather than merit. Numerous studies have shown that sex discrimination impedes a country’s economic growth. For a health care system to deliver efficient and high-quality care, patients must be prioritized based on their actual need and the urgency of their condition, not their social status or personal connections.

The key to successfully reducing discrimination is to recognize that it is a universal tendency that is embedded in our human nature, rather than a failing limited to those who are "unenlightened."

Discrimination does not occur only when an individual harbours overt prejudice or hatred towards a certain group of people. We are all prone to discriminate on the basis of unconscious biases that can guide our decision-making, especially when those decisions have to be made quickly, under pressure, or on the basis of limited information.

Every one of us needs to be mindful of the risk of discriminating whenever we are making decisions about people, especially those over whom we have some degree of power or influence. Even more importantly, we need to establish robust systems, policies, and procedures that reduce the potential for our biases to play a role in our decision-making. For example, when employers are hiring, they should review "blinded" resumés in which the applicants’ names have been blanked out, thus forcing the employer to focus on the applicants’ actual qualifications rather than their sex or ethnicity.

In the medical realm, physicians who are accepting new patients should do so on a first-come, first served basis. Prospective patients should not be subjected to a "screening visit" (sometimes known as a "patient audition") at which the physician decides whether or not to accept the individual as a patient. Any screening process creates enormous potential for discrimination, yet nine per cent of the physicians’ offices in our study engaged in this practice.

In Ontario, the College of Physicians and Surgeons has a formal policy that calls for physicians to accept patients on a first-come, first-served manner and explicitly states that it is inappropriate to screen potential patients. Such a policy should be strictly enforced and monitored across Canada. Physicians should welcome this action with open arms — in the interest of fairness to patients, and to set a good example for all in the fight against discrimination.


Stephen Hwang is an expert advisor with and a practicing physician in general internal medicine at St. Michael’s Hospital. He is also a research scientist at the centre for research on inner city health, Li Ka Shing Knowledge Institute, St. Michael’s Hospital and associate professor of medicine and director of the division of general internal medicine at the University of Toronto.




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