An investigation by a French team has revealed the extent to which sexism and racism are reflected in the diagnoses made by medical staff in emergency departments in France, Belgium, Switzerland and Monaco. The results show that black patients are taken less seriously and are less likely to receive emergency treatment in hospital.
“We sensed it, but we were surprised by the magnitude of the effect,” says Professor Xavier Bobbia, head of the emergency service at the University Hospital of Montpellier and coordinator of un study published in December in the international journal European Journal of Emergency Medicine. The study reveals the weight of sexist and racist prejudices in the diagnoses of patients treated in emergency services.
To carry out this experiment, during the summer of 2023, Professor Bobbia and his team sent a questionnaire to around 1,500 healthcare professionals (doctors and nurses) in 159 cities in France and neighboring countries: Belgium, Switzerland and Monaco. Faced with an identical symptom – chest pain that could be a sign of a heart attack – they were asked to give their opinion on the severity of the patients' cases.
A photo of the patients, all of them in their 50s, was provided and the test designer, who used artificial intelligence, devised eight different profiles of gender and ethnic appearance. “In France we have a legislative framework that means that in practice we cannot work with these issues (ethnic statistics). In our case, it was possible because we are not dealing with patients, nor with human beings who are given a label, but of images generated by artificial intelligence,” explains Professor Bobbia.
The research gave edifying results, as it reveals for the first time, with figures, that men are taken more seriously (in 62% of cases) than women (49%), and that the case is judged less serious when The person is of African descent: 47% of Afro patients were judged in a life-threatening situation, compared to 58% of white patients.
Black women are less likely to receive emergency treatment
Crossing the data, 63% of white men were placed in a life-saving situation, compared to only 42% of Afro women, with the same symptoms. Compared to a white male patient, black female patients are therefore less likely to receive emergency treatment.
This is a “huge variation”, according to Professor Bobbia, who describes the results as “interesting and worrying at the same time”. He had observed this trend in his daily work, and that is why he wanted to launch this research, but he did not expect such discrepancies. He refers to “unconscious clichés” that give rise to “sexist and racist” medical thinking.
A study on the sex of the medical personnel questioned for this investigation reveals that men and women perpetuate the same prejudices.
Professor Bobbia believes that these results are a reflection of more widespread prejudices: “Health professionals are not machines, they live in the middle of a society, and are contaminated by the same prejudices. I believe that our society as a whole has racist prejudices and sexist.” For this reason, the head of the emergency service at the Montpellier University Hospital recommends subjecting other professions in various fields to this type of test.
Similar discrimination in the United States and Canada
For health sociologist Laure Pitti, “the subordination and colonial history of France play a key role” in explaining these prejudices. The professor at the University of Paris 8 is not surprised by the conclusions of Bobbia's team.
“Other studies, carried out by health professionals, especially in Canada, or by sociologists, using a qualitative method – with a series of sufficiently numerous and recurring observations to be considered quantitative – have shown that people are taken less seriously. women, especially in cases of chest pain,” he explains.
Furthermore, in the United States, where ethnic statistics are authorized, numerous studies have revealed differences in the treatment of patients based on their skin color and, in particular, “the systematic undervaluation of pain experienced by black American patients.” black skin compared to white American patients. In 2016, an investigation showed that health professionals were based on racist prejudices, “a priori assuming that Afro people feel less pain than white people.”
In France, the errors of judgment revealed by the Montpellier team's study can have serious consequences for discriminated patients. “At the very least, a loss of opportunities. But it can even lead to death,” emphasizes Laure Pitti, recalling the case of some Afro women who died because the health system did not provide them with treatment.
A charge of “failure to assist a person in danger”
In 2018, a group of associations published a study that revealed cases of discrimination throughout the French emergency services chain. This initiative was taken after the death in December 2017 of Naomi Musenga, a 22-year-old girl from Strasbourg of Congolese origin. The young mother had called the emergency room because of severe pain, but her interlocutors did not take her seriously. She died of cardiac arrest less than three hours later. The operator who taunted Naomi Musenga was charged on January 12 with “failure to assist a person in danger.”
One of the hypotheses considered by associations and various journalistic investigations could be the racist stereotype of the “Mediterranean syndrome.” This is the widespread belief that patients in Mediterranean countries exaggerate their pain by shouting.
“In France, studies have shown that there is a recurring delegitimization of the pain of people 'perceived as other' and, therefore, 'altered', whether they come from North Africa, sub-Saharan Africa or the so-called 'gypsies'” , confirms Laure Pitti. “We sometimes call it Mediterranean syndrome, that is, the idea that patients on the southern shores of the Mediterranean exaggerate their symptoms. This causes their ailments to be discounted, which in turn causes delays in treatment and causes them to miss health opportunities.
Having an accent or not speaking French well is also one of the main reasons for refusing care, especially when making an appointment by phone, according to research carried out on discrimination in healthcare in France commissioned by the Ombudsman.
“Recognizing these prejudices does not mean tolerating them”
Xavier Bobbia hopes that becoming aware of prejudice and measuring it will inform healthcare personnel and medical students, because “recognizing prejudice does not mean tolerating it.” To solve this, the researcher and his team propose other solutions, including the systematic use of “objective evaluation guides” in emergency services, as already recommended by the French Society of Emergency Medicine, but which are not always applied.
These evaluation guidelines, based on heart rate, blood pressure and other objective criteria, are used to judge the level of priority and severity of patients received in emergency departments. According to the research team at the Montpellier University Hospital, artificial intelligence can also help provide an objective vision.
As for the medical staff, “they have given us very constructive comments about the study. The majority say that it is good to be aware (of prejudices) to be able to work on them,” explains Professor Bobbia.
Professor Bobbia's recommendations were also welcomed by Laure Pitti, who, however, is concerned about the evolution of the political context. With the reform of state medical aid (reserved for undocumented foreigners), one of the points of the immigration law approved by the French Parliament in December, the sociologist regrets a “harmful” political climate that risks affecting the fight against discrimination. “It is not when medical aid from the State is suppressed, that is, when it is considered
that foreigners are emptying the French health system, that the opposite reflexes will be created among health personnel.”
This text was adapted from its original in French.
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