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Why we all discriminate — even our doctors
And what we can do about it
A version of this commentary appeared in the Ottawa Citizen, Vancouver Province and the Windsor Star We sometimes imagine that discrimination is a blight conf ined to earlier times and f ar-away places. Unf ortunately, discrimination — that is, treating people better or worse simply because they are members of a particular socially-def ined group — occurs in every aspect of our lives today, f rom the workplace to the doctor’s of f ice. When researchers sent mock resumes in response to job postings in the Toronto area, a person with an Englishsounding name such as “John Martin” was 40% more likely to be of f ered an interview than a person with an ethnicsounding name such as “Arjun Kumar,” even when the two resumes listed exactly the same skills and qualif ications. 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’ of f ices in Toronto while playing the role of a person looking f or a f amily physician. Doctors’ of f ices were 58% more likely to of f er an appointment if the caller mentioned that he or she had a high-status job than if he or she mentioned receiving welf are. Even within the Canadian system of universal health insurance, people with high socioeconomic status receive pref erential access to health care. Why is discrimination a serious problem? Of course, discrimination is an af f ront to our innate sense of justice. We aspire to live in a world where people are treated f airly, 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 perf ormance and achievement. A society will ultimately be less successf ul if opportunities are made available to individuals on the basis of f avoritism rather than merit. Numerous studies have shown that sex discrimination impedes a country’s economic growth. For a health care system to deliver ef f icient 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. T he key to successf ully reducing discrimination is to recognize that it is a universal tendency that is embedded in our human nature, rather than a f ailing 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 inf ormation.

Every one of us needs to be mindf ul of the risk of discriminating whenever we are making decisions about people, especially those over whom we have some degree of power or inf luence. Even more importantly, we need to establish robust systems, policies, and procedures that reduce the potential f or 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 f orcing the employer to f ocus on the applicants’ actual qualif ications rather than their sex or ethnicity. In the medical realm, physicians who are accepting new patients should do so on a f irst-come, f irst 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 f or discrimination, yet 9% of the physicians’ of f ices in our study engaged in this practice. In Ontario, the College of Physicians and Surgeons has a f ormal policy that calls f or physicians to accept patients on a f irst-come, f irst-served manner and explicitly states that it is inappropriate to screen potential patients. Such a policy should be strictly enf orced and monitored across Canada. Physicians should welcome this action with open arms – in the interest of f airness to patients, and to set a good example f or all in the f ight against discrimination. Stephen Hwang is an expert advisor with EvidenceNetwork.ca 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; the Chair in Homelessness, Housing, and Health at St. Michael’s Hospital and the University of Toronto; and Associate Professor of Medicine and Director of the Division of General Internal Medicine at the University of Toronto.