He applied the “Page 99 Test” to his new book, Wait: The Art and Science of Delay, and reported the following:
Many studies have shown that bias and prejudice among doctors leads them to treat patients differently on the basis of race. Doctors are more likely to refer a patient suffering chronic renal failure for a kidney transplant if he is white than if he is black. Doctors treating heart attacks are up to twice as likely to administer a thrombolytic drug meant to break up clots in the coronary arteries if the patient is white than if he is black. In general, doctors are more likely to provide treatment and medication—whether for psychiatric illness, cancer, or broken bones—for whites than for blacks.Read more about the book and author at Frank Partnoy's website and blog.
One of the main arguments of Wait is that we will make better decisions if we first pause as long as possible. We are better at apologizing, dating, sports, and military tactics when we wait a little bit, even if it is just a few minutes, seconds, or even milliseconds. We are happier and better off when we delay gratification. Page 99 of Wait describes how this argument holds for racially biased doctors.
For the book, I interviewed Dana Carney, a professor at Berkeley, and one of seven authors of a major study of implicit doctor bias. In the study, she and her co-researchers had presented several hundred resident physicians at four academic medical centers in Boston and Atlanta with a hypothetical scenario in which a fifty-year-old male patient named Mr. Thompson showed up at an emergency room with chest pain (“sharp, like being stabbed with a knife”). The researchers gave the doctors a photograph of the man, along with details about his medical condition. To test how the patient’s race might influence the doctors’ answers, the researchers randomly varied the race of the man in the photograph. As a result, some doctors thought Mr. Thompson was white; others thought he was black. The researchers then asked whether the doctors would prescribe thrombolysis, a blood-clotting procedure.
The results fit with previous studies: the doctors were significantly more likely to prescribe thrombolysis for a white patient than a black one. The doctors didn’t appear racist, yet they treated blacks differently (by undertreating them)—the very definition of racism.
But Carney’s co-authored study introduced a surprising twist: the doctors who were aware that the test was designed to test implicit racism – and therefore paused to think about their own potential bias – behaved very differently.
From Page 99:
When Dana Carney and her colleagues conducted the doctor study, they were worried that some participants might figure out that the study was designed to test implicit racism and thereby skew the results. So they asked the doctors to say what they thought the purpose of the study was. That question inadvertently revealed a possible solution to the problem of implicit racism.
Doctors are smart and perceptive, and the IAT is well known at medical schools. Some of them wondered why the researchers would include a photograph of Mr. Thompson. About one-quarter of the doctors surmised that the study was designed to test racial bias, even before the researchers asked any questions.
The researchers excluded those doctors from their main results, but also saw this subgroup as an opportunity. They separately checked to see if these doctors recommended different treatment than the others. They did. Although this “aware” subgroup, like their peers, showed an implicit preference for whites over blacks on the IAT, they actually prescribed more, not less, thrombolysis for black patients. In other words, once the doctors understood that race was an issue, race was no longer an issue. They counterbalanced their implicit bias, like a driver adjusting to a misaligned steering wheel.
The Page 99 Test: The Match King.