8 Evidence-Based Implicit Bias Implications for Physicians and Healthcare Professionals Summary
INTRODUCTION Although implicit or unconscious bias and its impact on healthcare can be understood in relationship to a range of identity characteristics (age, gender, sexual orientation, etc.), implicit bias related to race is particularly salient in the United States. This focus on racial implicit bias can be understood in the context of the history of race and racism in America. THE ENSLAVEMENT OF AFRICANS The first Africans were brought to this country forcibly on ships, arriving on the Southern shores of our nation. Packed body-next-to-body in the hull of ships, those that survived disease, malnutrition, and abuse entered this country as cargo…property. White farmers and various businessmen purchased Africans to plant and harvest crops and to cook, clean homes, and care for their children. They were the property of the individuals and families that purchased them. This forced enslavement of Africans was maintained by a system of inhumane physical and psychological abuse, norms, accepted practices, and laws. As property , Africans weren't considered human. They were property to be purchased, sold, and even named in the will of individuals before they died, like one might leave a house or wagon to a spouse or children. Like the evaluation or assessment of a used car or house, enslaved Africans were evaluated and rated according to their fitness and/or physical defects. They were not viewed as human beings on par with Whites. In the 18th and 19th century, the support of this belief of inhumanity took the form of scientific racism or pseudoscience. Many people, both professionals and laypersons, thought that Black people had an innate tendency to want to run away from the confinement of the plantation, had thicker skin and skulls, and had fewer nerve endings and therefore could endure more pain.
LEARNING TIP! This rationale was often used for the extreme brutalization and whipping experienced by Black men, women, and children. These beliefs contributed to the medical experimentation conducted on African American bodies, sometimes without any attempt to reduce the pain and suffering of Black patients or experimental subjects.
Although current laws, policies, and accepted medical practices have eliminated the horrendous abuses of Black bodies, it is important to recognize how deeply embedded many of the beliefs and perceptions of Black people are within American culture, consciously and implicitly. A 2016 study revealed that almost half of the medical students and residents surveyed endorsed notions of pseudoscience, believing that Black people had thicker skin, less sensitive nerve endings, and experienced less pain than Whites. In spite of conscious endorsements of equity, fairness, social justice, and providing the highest level of care, there is this parallel process of unconscious or implicit bias. It is not that providers are inherently bad. Rather, they are human and prone to internalize, to a greater or lesser extent, the beliefs and stereotypes resulting from centuries of systemic and structural racism. These beliefs and internalized stereotypes can cause physicians to behave in ways that violate their deeply held values of fairness and equity. The process is unconscious or implicit.
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