Fincher Contessa, Williams Joyce E, MacLean Vicky, Allison Jeroan J, Kiefe Catarina I, Canto John
Institute of Medicine, Washington, DC 20001, USA.
Ethn Dis. 2004 Summer;14(3):360-71.
To interpret, within a sociological context, evidence of physician bias in the management and outcomes of coronary heart disease (CHD) treatment for African Americans vs Whites.
Articles addressing race and ethnic disparities in CHD, and gender as an additional risk factor, published since 1980, were searched and reviewed. Source material was identified using the electronic search engines for MEDLINE and Sociological
Articles were included in the review of race or ethnic disparities in heart disease when they provided direct or indirect evidence of potential sources of physician bias and/or differential treatment for CHD. Three types of studies suggest the presence of physician bias, and include those demonstrating: 1) patterned disparities in treatments and interventions; 2) practitioner perceptual bias/stereotyping of patients; and 3) patient perceptions of bias in treatment.
A growing body of research supports the presence of physician bias in differential treatment practices for CHD based on patient race/ethnicity, and sometimes patient gender and socioeconomic status, which manifests as additional risk factors in the quality of care, pharmacological therapy, and use of invasive procedures. Access to care and patient preferences/behaviors do not fully account for racial disparities in CHD treatment.
Socioeconomics, individual racism, and institutional racism represent 3 predominant pathways to differential treatment for CHD that are mediated by the patient-provider relationship. Racial biases are shown to be a part of the social structure of medical practices at both the macro and micro levels. Individual healthcare providers can potentially reduce disparities in Black-White CHD treatment and outcomes by examining the patient-provider relationship for bias. Future studies will require addressing more direct ways of measuring, monitoring, and reducing subtle bias in the healthcare system.
在社会学背景下解读关于非裔美国人和白人在冠心病（CHD）治疗管理及治疗结果方面存在医生偏见的证据。
检索并回顾了自1980年以来发表的探讨冠心病中种族和民族差异以及将性别作为额外风险因素的文章。使用MEDLINE和社会学电子搜索引擎识别源材料。
当文章提供了医生偏见潜在来源和/或冠心病差异治疗的直接或间接证据时，这些文章被纳入心脏病种族或民族差异的综述。有三种类型的研究表明存在医生偏见，包括那些证明：1）治疗和干预方面的模式化差异；2）从业者对患者的认知偏见/刻板印象；3）患者对治疗中偏见的认知。
越来越多的研究支持基于患者种族/民族，有时还基于患者性别和社会经济地位，在冠心病差异治疗实践中存在医生偏见，这在医疗质量、药物治疗和侵入性手术的使用方面表现为额外的风险因素。获得医疗服务的机会以及患者的偏好/行为并不能完全解释冠心病治疗中的种族差异。
社会经济、个体种族主义和制度性种族主义是冠心病差异治疗的3条主要途径，由医患关系介导。种族偏见在宏观和微观层面都被证明是医疗实践社会结构的一部分。个体医疗服务提供者可以通过检查医患关系中是否存在偏见，来潜在地减少黑人和白人在冠心病治疗及治疗结果上的差异。未来的研究将需要探讨更直接的方法来测量、监测和减少医疗系统中的微妙偏见。
