How welcome is the patient in our office and waiting room who is different from ourselves? Does the patient who is less educated, poor, or from a different culture feel comfortable? How do these differences affect their care, if in fact they do?
Current emphasis on evidence-based medicine and its application in the arenas of clinical treatment and health policy development have been noteworthy. Its antithesis, prejudice-based medicine, is not as well-studied and is not considered as carefully in current medical practice. Prejudice—making assumptions and decisions based on inaccurate or faulty information and assumptions—is the stuff of history. At various times we have shown ourselves capable, through a variety of psychological maneuvers, of parlaying spurious data about the objects of prejudice into discriminatory practices. This discrimination has run the gamut, from denial of various rights and services to genocide. No one is immune from prejudice; thus, it is hardly surprising that it has an effect on how we practise medicine.
Recent work, particularly by the Institute of Medicine—an American nonprofit organization that provides evidence-based information and advice on matters of medicine and health—has suggested that prejudice and discrimination directly affect the receipt of much needed health care services in certain groups. Commissioned by the US Congress to study racial and ethnic disparities in health care, they found that health care providers’ behaviour, assumptions, and attitudes can have a detrimental influence on the health of those who seek care.1