In this blog Leslie Njingang explores the hidden threat of the misdiagnosis of Long Covid due to bias around race, ethnicity, religion, gender, weight, age, and more, and looks at recommendations for addressing this implicit bias and misdiagnosis.
In the past year alone, the number of people who have had Long Covid in the United States has risen from 15.7 to 18.4 percent. Despite the increasing trend in Long Covid cases, patients face challenges getting healthcare providers to believe and accurately diagnose them. Some of this can be attributed to a lack of knowledge about Long Covid among providers, given the newness of this chronic condition and the range of symptoms presented. Still, for some, it’s apparent that implicit bias has been the contending force behind a misdiagnosis.
Implicit bias and its impact on Long Covid patients
Implicit bias refers to the attitudes or stereotypes healthcare providers may hold that unconsciously influence their assessment, understanding, actions, and decisions. These biases can be directed against any group perceived as “others,” including those defined by race, ethnicity, religion, gender, weight, age, and more. Long Covid patients most notably perceived biases against their race, gender, weight, and age.
Specifically, racial bias has led to Long Covid patients feeling they experience different standards of care and treatment, with some patients describing what felt like “Black Covid” vs. “White Covid.” Common experiences for women with Long Covid were their healthcare providers attributing their symptoms to anxiety or menopause due to implicit biases related to women exaggerating their pain.
Another group that felt treated differently in response to medical bias was patients who had a high BMI. These patients reported that providers dismissed their Long Covid concerns and, instead, asserted that symptoms overweight patients were experiencing were simply typical health complications that accompanied their body size.
Beyond weight, Long Covid patients also call out the bias healthcare providers held against certain age groups. Healthcare providers often assumed young people were too young to have serious health issues, while older patients had their symptoms blamed on the natural aging process, as opposed to Long Covid. The age bias against the younger and older populations resulted in both age groups feeling as if they were not being taken seriously.
The different types of biases people with Long Covid encounter reveal significant implications for patient care, particularly misdiagnosis. When healthcare providers believe stereotypes such as the myth that ‘Black people don’t feel pain,’ they are inclined to dismiss symptoms or experiences expressed by their patients. Consequently, they fail to recognize the totality of the patient’s experience as potentially being Long Covid related.
Consequences of Misdiagnosis in Long Covid
In essence, implicit bias against Long Covid patients can lead to misdiagnosis, with profound repercussions. Misdiagnosed patients cannot access necessary treatment to manage their symptoms and face delays in getting specialist referrals. Typically, patients require a Long Covid diagnosis before they can access further targeted care. A misdiagnosis therefore extends the timeline of an already time-consuming process.
Not only does a misdiagnosis postpone care, but it also means that patients are forced to endure unnecessary pain and discomfort, severely affecting their quality of life. One study showed that Long Covid patients experienced limitations in daily activity and mobility, a high level of pain, and increased anxiety or depression, with all participants reporting that their general well-being was moderately (43%) or severely impacted (33%) by symptoms.
This physical and emotional toll can be compounded by the erosion of trust misdiagnosis causes. When patients feel that their symptoms are not taken seriously or are attributed to factors that they cannot change, such as their race or gender, they may become disillusioned with the medical profession. This erosion of trust can make marginalized groups less likely to seek medical help in the future, exacerbating health issues and disparities.
Recommendations for addressing implicit bias and misdiagnosis in Long Covid care
Implicit bias and corresponding misdiagnosis negatively impact Long Covid patients’ health and health experience. When clinicians do not acknowledge their implicit biases, they cannot take the necessary steps to reduce them. However, it’s not enough to recognize that sexism, ageism, racism, and weightism can negatively affect clinical interaction outcomes, play a role in health disparities, and affect treatment adherence, healthcare professionals should actively strive to reappraise and mitigate their biases.
To address this, many healthcare professionals are adopting patient-centered care in their approach to assessments. Patient-centered care involves respecting and responding to the individual preferences, needs, and values of patients. By taking the time to listen carefully to Long Covid patients’ descriptions of their symptoms and experiences, without preconceived notions or biases, providers can foster. Healthcare professionals will also be able to gather more accurate information, leading to better diagnoses, more effective treatment plans, and a relationship built on trust.
Lastly, it is imperative that healthcare providers and the general public (especially those who have had COVID-19 in the past) continuously build upon their knowledge of Long Covid. The evolving nature of this condition means that staying informed about the latest research, treatment protocols, and potential symptoms is crucial. Providers should engage in ongoing education and training to better understand Long Covid and its varied manifestations, and patients should take advantage of the numerous online support groups aimed at educating about Long Covid and available services. These tools and strategies can overcome implicit biases and misdiagnosis, ultimately leading to improved health outcomes for patients.
Leslie Njingang is a third-year student at the University of Pennsylvania. As a research intern at Johns Hopkins Bloomberg School of Public Health, she conducted a scoping review on Long Covid patient experiences, inspiring her to write this piece. Leslie is passionate about healthcare and aims to contribute to better patient care through her work.
Photo Credit: Nielsen, Klaus. Doctor showing diagnosis to black patient in hospital. 30 Nov. 2020. Pexels, Creative Commons, https://www.pexels.com/photo/doctor-showing-diagnosis-to-black-patient-in-hospital-6303652/. Accessed 2024.
