The impact of patient race, patient socioeconomic status, and cognitive load of physician residents and fellows on chronic pain care decisions

Social stereotypes are more likely to influence decision-making under conditions of high cognitive load (i.e., mental workload), such as in medical settings. We examined how patient race, patient socioeconomic status (SES), physician cognitive load, and physician implicit beliefs about race and SES differences in pain tolerance impacted physicians’ pain treatment decisions. Physician residents and fellows (N=120) made treatment decisions for 12 computer-simulated patients with back pain that varied by race (Black/White) and SES (low/high). Half of the physicians were randomized to be interrupted during the decision task to make hypertension medication conversion calculations (high cognitive load group), while the other half completed the task without interruptions (low cognitive load group). Both groups were given equal time to make pain care decisions (2.5 minutes/patient). Results of multilevel ordinal logistic regression analyses indicated that physicians prescribed weaker analgesics to patients with high vs. low SES (OR=.68, 95% CI [0.48, 0.97], p=.03). There was also a patient SES-by-cognitive load interaction (OR=.56, 95% CI [0.31,1.01], p=.05) that is theoretically and potentially practically meaningful but was not statistically significant at p<.05. These findings shed light on physician cognitive load as a clinically relevant factor in the context of pain care quality and equity.