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Cited by 213Clinical Reasoning and Diagnostic SkillsCultural Competency in Health CareDiversity and Career in Medicine

Are Providers More Likely to Contribute to Healthcare Disparities Under High Levels of Cognitive Load? How Features of the Healthcare Setting May Lead to Biases in Medical Decision Making

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Burgess, Diana J.·2010·Medical Decision Making
DOI 10.1177/0272989x09341751PMC PMC3988900
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Abstract

Systematic reviews of healthcare disparities suggest that clinicians’ diagnostic and therapeutic decision making varies by clinically irrelevant characteristics, such as patient race, and that this variation may contribute to healthcare disparities. However, there is little understanding of the particular features of the healthcare setting under which clinicians are most likely to be inappropriately influenced by these characteristics. This study delineates several hypotheses to stimulate future research in this area. It is posited that healthcare settings in which providers experience high levels of cognitive load will increase the likelihood of racial disparities via 2 pathways. First, providers who experience higher levels of cognitive load are hypothesized to make poorer medical decisions and provide poorer care for all patients, due to lower levels of controlled processing (H1). Second, under greater levels of cognitive load, it is hypothesized that healthcare providers’ medical decisions and interpersonal behaviors will be more likely to be influenced by racial stereotypes, leading to poorer processes and outcomes of care for racial minority patients (H2). It is further hypothesized that certain characteristics of healthcare settings will result in higher levels of cognitive load experienced by providers (H3). Finally, it is hypothesized that minority patients will be disproportionately likely to be treated in healthcare settings in which providers experience greater levels of cognitive load (H4a), which will result in racial disparities due to lower levels of controlled processing by providers (H4b) and the influence of racial stereotypes (H4c).The study concludes with implications for research and practice that flow from this framework.

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Authors
Burgess, D. J.
Affiliations
University of Minnesota (US)
Corresponding author
Burgess, Diana J.
ORCID
Burgess, Diana J.
Venue
Medical Decision Making
Publisher
SAGE Publications
Published
2009-09-02
Volume
30
Issue
2
Pages
246-257
ISSN
  • 0272-989X (ISSN-L)
  • 1552-681X
DOI
10.1177/0272989x09341751
PMC
PMC3988900
OpenAlex
W2011620831
Cited by
213
References
155
Citations by year
2026: 12 · 2025: 12 · 2024: 21 · 2023: 21 · 2022: 21 · 2021: 15 · 2020: 18 · 2019: 14 · 2018: 15 · 2017: 15 · 2016: 10 · 2015: 10 · 2014: 6 · 2013: 9 · 2012: 2
FWCI
3.40
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Medical Decision Making (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Funders
National Heart, Lung, and Blood Institute (R01HL085631)
Topics
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
  • Social Sciences › Gender Studies › Diversity and Career in Medicine
Keywords
health care disparities, racial disparities, cognitive load, racial stereotypes, controlled processing, provider bias
MeSH terms
Decision Making, Health Personnel, Health Services Research, Humans, Physician-Patient Relations, Prejudice, Workload, Racial Groups, Healthcare Disparities

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