Diagnosis is a series about the past, present and future of a medical cornerstone. It examines all aspects of diagnosis, how it happens, how it can be shaped by history or human bias, and how a diagnosis can itself affect a patient’s health. In this episode:

As Dr. Eric Rosenberg noted in our first episode of the Diagnosis podcast, turning test results and medical histories into a diagnosis still relies on the human brain, and each clinician’s brain comes with its own all-too-human presets. In recent decades, there has been a concerted effort to map where physicians may fall prey to unconscious bias. This is especially important for bias that involves perceptions of underserved groups, including women and racial minorities. Many studies have shown how bias can lead to subpar care for these groups. Female patients, for instance, have been shown to need more visits before they initially receive a diagnosis, perhaps because clinicians at first discount their worries. Black Americans, similarly, are more likely to have their accounts of pain dismissed, a lost signal that can lead to an important diagnosis being missed or delayed. Illness that affects the brain has especially drawn scrutiny. Race appears to affect the judgment of many clinicians. Stroke, epilepsy and Parkinson’s disease are less well diagnosed among Black patients. Black children are less likely to get a diagnosis of ADHD than their white counterparts. And while Black Americans are almost twice as likely to develop Alzheimer’s disease and other dementias, they are 35% less likely to be diagnosed with those conditions. There are also instances where concepts from neurology have been used as a weapon by those outside the profession. In the deaths of George Floyd, Daniel Prude and Elijah McClain, three Black men who were killed in police custody, a factor noted in each death was excited delirium, a diagnosis not listed in any major disease or syndrome manual.

Joining the Proto podcast to talk about bias in neurology is Dr. Altaf Saadi. Dr. Saadi is a neurologist at Massachusetts General Hospital and a principal investigator in the Neurodisparities and Health Justice Lab. Dr. Saadi is the co-author of a new article in the journal Neurology that provides a comprehensive review of race-based disparities in the field.