Health-care reform has a different meaning for Augustus White (AMP 94, 1984) than the definition you might get from a policy wonk: His reform would ensure equality of medical treatment, no matter the color of your skin, gender, or sexual preference.

White is the Ellen and Melvin Gordon Distinguished Professor of Medical Education and professor of orthopedic surgery at Harvard Medical School and was the first African American department chief at Harvard’s teaching hospitals. In his new book, Seeing Patients: Unconscious Bias in Health Care (Harvard University Press), with David Chanoff, White cites a library full of studies (some his own) as well as his own personal experiences to document that minorities receive a lower standard of health care than do white men.

For example, he writes, African Americans receive fewer operations than whites for lung cancer, fewer hip replacements, fewer kidney and liver transplants, and less pain medication when they are operated on. Furthermore, women with heart disease receive less angioplasty than men; Hispanics have a lower rate of recommended health-care services such as colonoscopies and flu vaccines; and male homosexuals and bisexuals often have serious ailments unnoticed during primary care exams.

White learned the lesson early on. As a young medical student in Memphis, he watched a black woman being operated on for uterine cancer, a procedure botched by the white surgeon who, frustrated at the way things were going, simply gave up and let the patient die in her own blood. White writes: “I don’t think it had quite hit me at that point that I was on the verge of entering a profession where white doctors treating black patients was the rule, and that there was a host of often hidden emotions and attitudes associated with that.”

The causes for unequal treatment, White tells us, range from outright racism to something more insidious: the unrecognized biases of otherwise broad-minded, highly educated doctors who believe at some unconscious level, for example, that African American men are more tolerant of pain, or whatever stereotype allows a resident to examine a black patient without drawing the curtain.

White also blames the medical culture, which conditions physicians to “focus on the patient’s physiological symptoms and biomedical indications and discourages them from taking into account the social context.”

As a prescription, White recommends training in cultural competence and self-awareness in medical schools as well as ongoing professional training. A white physician, for example, should learn not to call new African American patients by their first name and to understand Middle Eastern taboos about cross-gender touching before beginning an exam.

White’s story — part autobiography, part call to action — is a compelling and often uncomfortable read about a hidden world where even the most compassionate and egalitarian caregivers often fail a basic command of the Hippocratic oath: to do no harm.

— Sean Silverthorne

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