I don't know why this is downvoting to the point of being greyed out.

Doc here: nothing in the post above is controversial or new to anyone even vaguely aware of the literature.

It is true, and a major confounder of the study to the point of rendering it utterly fucking useless, that AA = lower SES = shittier hospital.

The remainder of the points in the above post are also heavily corroborated and true - although it should be noted that they suffer from essentially the same bias as the parent article, which OP did not mention. There's also AA = lower SES = hospital that sees a shit-ton of lying addicts come through the doors, making docs distrustful of anyone that can even vaguely fit the stereotype.

It is notable however that the 'docs are racist and give less accurate treatment when biased' bit is not statistically significant.

It's also... just... kind of complicated?

I have a story I'll never forget, from my training days.

We had a lady come in with severe lower back pain, two weeks post-discharge from a complicated UTI. CT she'd gotten during last admit showed some osteoporosis of the lumbar spine. Working hypothesis was UTI, or maybe it ascended to pyelo. Patient had 10/10 please-don't-touch-me-or-look-at-me pain, and a distant (or "distant"?) history of IV drug abuse.

Test test test, okay, not a UTI. Took some fresh imaging exploring the spine some more, and looks like she had a collapsed vertebra. The correlation between loss of spinal integrity of imaging and pain is loose, but, let's look into that.

Also, this lady is constantly asking for more pain meds. There's not enough in the world for this lady.

When we come by to visit her, a couple of times she's... well, it basically looks like "oh, the docs are coming, quick, lay back down and look worse." Nurses confirm.

Conversation in the on-call room, amidst a group of residents and attending that covers pretty much every ethnicity and gender, goes something like:

"She looks like she's exaggerating."

"Nurses say the same."

"Could be. But she could be exaggerating because she's faking, or she could be trying to make sure we don't take her pain less seriously than it deserves, and is afraid if she looks OK for a moment we will."

"That's true. Also, she's black, and I am afraid of unconscious bias that may be playing a role here."

"I too am afraid of that. But she's also being visibly deceptive, and she Does have a history of drug abuse. When she got her pain managed last time she was here, could we have knocked her off the wagon?"

"That history of addiction was ages ago."

"But you can't cure addiction, you can just do your best to stay clean."

etc. Very self-aware, very consciously attempting to not be "despicable racists that treat black children worse than animals."

We consulted pain management, who said our pain management regimen was reasonable.

The result was that we managed to talk ourselves out of chasing her pain with opioids - that is, we kept her at a reasonably high level of analgesia, which she was crying was not at all close to enough - and had interventional radiology give her a vertebroplasty.

24 hours after the procedure she stopped asking for opioids; 48 hours out she left the hospital on motrin. All signs of dubious behavior were utterly gone.

She had just been in pain. We did everything we could to do the right thing. It wasn't enough.

We had a diverse group of physicians. We thought long and hard. We discussed at length the effects of bias. We consulted with outsiders. We debated some more. We did our level best. And we still, I think, fucked up.

All I mean to say is: it's way more complicated than "white doctors are racists are terrible."