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may be a factor in heart care
(AP) -- Unconscious prejudices among doctors may help explain why women and blacks complaining of chest pain are less likely than men and whites to receive the best cardiac testing, a study suggests. Researchers have found such differences in care previously, and have attributed them to financial barriers and differences in patients' preferences, medical condition and access to care.
However, a new study of 720 physicians found that, with all symptoms being equal, doctors were only 60 percent as likely to order cardiac catheterization for women and blacks as for men and whites.
For black women, the doctors were only 40 percent as likely to order catheterization.
Catheterization is considered the "gold standard" diagnostic test for heart disease. It involves squirting dye into cardiac arteries, then X-raying them to find blockages and determine the best treatment.
"Most likely this is an underestimate of what's occurring," Dr. Kevin Schulman of Georgetown University Medical Center said, because the doctors knew their decisions were being recorded -- although not why. In the unusual study, doctors attending medical conferences were told they were participating in a study of clinical decision making, and viewed medical data and a taped interview with one of eight "patients." The patients were really actors.
There were two black women, two black men, two white women and two white men, divided into two identical groups. In one group, all the patients were said to be 55; in the other group, 70. The actors described identical symptoms. Information such as insurance coverage, profession and results of a heart stress test also were the same.
Still, researchers found disparities in doctors' treatment recommendations.
"We still need to understand a lot more about why these differences occur," Schulman said. "This may all be subconscious."
The research was reported in Thursday's New England Journal of Medicine. Another journal report suggests black patients with congestive heart failure have a higher risk of death or worsening disease than whites getting similar treatment. In congestive heart failure, the heart's ability to pump blood gradually declines, causing pain, shortness of breath and other symptoms.
Researchers at the National Heart, Lung and Blood Institute, examining data from an earlier cardiac study, found 42 percent of blacks treated for such symptoms died, compared with 36 percent of whites. For patients with the disease but no symptoms yet, 22 percent of blacks died vs. 14 percent of whites.
Previous studies found higher death rates for blacks, but cited factors such as differences in disease severity or access to care. These researchers took those factors into account, and instead concluded that hormonal differences between races may affect survival