markedly less likely to undergo bypass surgery. The racial difference was largest among patients with severe disease—those who would benefit the most. Moreover, compared to Whites, Blacks had a higher five-year mortality rate, which was partly explained by differences in treatment. Hannan et al. (1999) followed for three months a random sample of 4,905 patients undergoing angiography to determine racial differences in the receipt of coronary artery bypass graft (CABG) surgery. They found that among patients judged as appropriate for CABG using rigorous criteria, Black and Hispanic patients were about 1.6 times less likely than non-Hispanic Whites to receive the surgery, even after adjustment for age, gender, insurance status, and vessels diseased. Moreover, Blacks, but not Hispanics, were 1.6 times less likely than Whites to receive the surgery among patients for whom CABG surgery was judged to be necessary. In addition, the study interviewed the gatekeeper physician for a random sample of patients appropriate for CABG surgery who did not receive it. For 90 percent of this group, the physician indicated that he/she had not recommended surgery. Among those patients who were not recommended for CABG surgery, in 9 percent of the cases, the patient preferred another intervention; in 8 percent, the physician preferred another intervention first. Thus, patient preference did not play a major role in accounting for racial differences in CABG surgery.

Taken together, the research on racial differences in medical care raises uncomfortable questions about the prevalence of racial bias among America’s physicians. Health-care providers are a part of society and share, to some degree, prevailing negative beliefs about Blacks and other racial groups, as reflected in the stereotype data reviewed in Table 14–14. Consciously or unconsciously, race appears to influence the practice of medicine. In a world of finite medical resources, larger societal beliefs about the intellectual capacities, violent nature, and laziness of racial groups may creep into clinical decision making to establish the worthiness, or lack thereof, of some patients for the receipt of medical care. More research is clearly needed on provider attitudes and behaviors (King, 1996). More important is the urgent need for the organizations responsible for medical education, training, and licensure to develop and implement strategies to eradicate racial inequities in medical care. They should also establish strong countervailing influences to combat tendencies toward racial prejudice and bias (Williams, 1998).

A small but growing body of research also indicates that chronic and acute experiences of discrimination in the lives of minority group members is a source of stress that adversely affects their physical and mental