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Colorblind Racial Ideology and Physician Use of Race in Medical Decision-Making

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Abstract

Background

Colorblindness is a racial ideology that minimizes the role of systemic racism in shaping outcomes for racial minorities. Physicians who embrace colorblindness may be less likely to interrogate the role of racism in generating health disparities and less likely to challenge race-based treatment. This study evaluates the association between physician colorblindness and the use of race in medical decision-making.

Methods

This is a cross-sectional survey study, conducted in September 2019, of members of the Minnesota Academy of Family Physicians. The survey included demographic and practice questions and two measures: Color-blind Racial Attitudes Scale (CoBRAS; measuring unawareness of racial privilege, institutional discrimination, and blatant racial issues) and Racial Attributes in Clinical Evaluation (RACE; measuring the use of race in medical decision-making). Multivariable regression analyses assessed the relationship between CoBRAS and RACE.

Results

Our response rate was 17% (267/1595). In a multivariable analysis controlling for physician demographic and practice characteristics, CoBRAS scores were positively associated with RACE (β = 0.05, p = 0.02). When CoBRAS subscales were used in place of the overall CoBRAS score, only unawareness of institutional discrimination was positively associated with RACE (β = 0.18, p = 0.01).

Conclusions

Physicians who adhere to a color blind racial ideology, particularly those who deny institutional racism, are more likely to use race in medical decision-making. As the use of race may be due to a colorblind racial ideology, and therefore due to a poor understanding of how systemic racism affects health, more physician education about racism as a health risk is needed.

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Data Availability

Data can be made available upon request.

Code Availability

Code can be made available upon request.

MSC Classification Code

Not applicable.

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Funding

This research was funded by the Minnesota Academy of Family Physicians Resident Innovation Grant, the NRSA grant from the Health Resources and Services Administration (5 T32 14001) and the National Institute of Health (5 K23 HL143146 02).

Author information

Authors and Affiliations

  1. Department of Family Medicine, University of North Carolina School of Medicine, 590 Manning Dr, Chapel Hill, NC, 27514, USA

    Ebiere Okah

  2. Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA

    Janet Thomas

  3. Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA

    Andrea Westby & Brooke Cunningham

Authors
  1. Ebiere Okah
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  2. Janet Thomas
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  3. Andrea Westby
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  4. Brooke Cunningham
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Contributions

All the authors contributed to study conception, design and material preparation. Data collection and analyses were conducted by Dr Okah, and reviewed by all authors. The first draft was written by Dr Okah and reviewed and edited by all authors. All authors contributed to the preparation of the final manuscript.

Corresponding author

Correspondence to Ebiere Okah.

Ethics declarations

Ethics Approval

The study was evaluated by the University of Minnesota Institutional Review Board and considered exempt due to not being  research involving human subjects.

Consent to Participate

Participants signed an online consent form prior to proceeding to the online survey.

Consent for Publication

This project was deemed as not being research involving human subjects..

Competing Interests

The authors declare no competing interests.

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Okah, E., Thomas, J., Westby, A. et al. Colorblind Racial Ideology and Physician Use of Race in Medical Decision-Making. J. Racial and Ethnic Health Disparities 9, 2019–2026 (2022). https://doi.org/10.1007/s40615-021-01141-1

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  • DOI: https://doi.org/10.1007/s40615-021-01141-1

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