476 Racial knowledge and its impact on physicians’ decision making: insights from a factorial survey in Germany

Abstract OP 9: Health Services 1, B210 (FCSH), September 3, 2025, 15:45 - 16:45 Aims Current scholarship on racism in healthcare frequently attributes racial disparities to individual bias, overlooking the structural and epistemic mechanisms through which racial knowledge is institutionalized. This study advances a critical analysis with two core objectives (1) to measure the persistence of racial behavioral stereotypes in medical practice, and (2) to evaluate their influence on diagnostic decision-making, thereby interrogating how structural racism operates through ostensibly neutral clinical protocols. Moving beyond frameworks that conceptualize racism as unconscious cognition, we investigate how racial assumptions about patient physiology and health behavior—rooted in medical epistemology and institutional norms—shape disparities in care. Methods A national online survey of n = 1,210 internal medicine physicians across German hospitals was conducted, incorporating clinical vignettes to assess the influence of racialized knowledge on diagnostic decisions. Ordered logistic regression models analyzed disparities in perceived disease severity and likelihood of angina pectoris diagnosis, controlling for demographic and professional variables. The vignettes systematically varied patient racialization (racialized as Persons of Color vs. white) while holding clinical presentation constant, enabling isolation of racialized assumptions in assessments of symptomatology and treatment recommendations. Results While explicit biological essentialism was largely rejected, racialized behavioral stereotypes (e.g., assumptions about compliance, health literacy) persisted, reflecting a reliance on cultural narratives to interpret patient behavior. Symptoms of patients racialized as PoC were perceived as less severe compared to racially white patients, demonstrating how racialized knowledge directly distorts clinical judgment. Conclusions This study demonstrates that racial inequities in healthcare are sustained not merely by individual prejudice but by institutionalized epistemic frameworks that naturalize racial hierarchies. Reforming medical education to address implicit bias alone is insufficient; dismantling structural racism requires confronting the historical and epistemological foundations of racialized medical knowledge. It is therefore necessary to implement interventions that reconfigure institutional practices, training paradigms, and accountability mechanisms.