11 Evidence-Based Implicit Bias Implications for Physicians and Healthcare Professionals: Summary
Question 2: Why might some Black patients question White providers about their background and experience in working with Black patients? Commentary on question 2 : The history of race relations in America has contributed to many divisions. White providers may not have many close friends who are Black or spend significant amounts of time in predominantly Black communities. Stereotypes about casually dressed young Black men may operate for some providers. Healthcare Research
In research by Mende-Siedlecki and colleagues, White providers demonstrated more stringent thresholds in perceiving pain on Black faces versus White faces, and those with more stringent thresholds for Black patients prescribed fewer non-narcotic pain relievers. Studies about implicit bias and pain indicate that Black women are often not believed when they express their pain level. Race of the woman appears to be A strong factor of implicit bias in maternal care. Research related to race and childbirth indicates that Black women are twice as likely to deliver a premature baby than White women. Studies of women dying during childbirth or during the postpartum period indicates Black women are 3-4 times more likely to die during childbirth than White women. Implicit bias has also been shown to impact the quality of the clinical encounter, particularly communication. Provider race bias on the IAT was associated with lower quality communication with Black patients, such as more provider verbal dominance, lower patient positive affect, poorer patient ratings of interpersonal care, lower perceptions of respect from clinicians, and lower likelihood of recommending the clinician. Additionally, an example of bias via non-verbal communication is medical professional standing further away from a black patient.
In addition to a provider’s conscious adherence to high ethical standards and a commitment to quality care, they are also subject to implicit bias, like the rest of the population. The national interest in implicit bias in healthcare intensified when the Institute of Medicine delivered their report, 'Unequal Treatment,' in 2003 . It concluded that implicit bias against social groups, including racial and ethnic groups, can impact the clinical encounter. Much of the research supporting this report utilized the online Implicit Association Test (IAT). The IAT measures the strength of associations between concepts such as Black or White, old or young, good or bad, desirable or undesirable, and dangerous or friendly. The reaction time (association) to various pairs of words or photographs is a measure of the strength of the association. Millions of people used this website (operated by Harvard University) to take the IAT or one of the other tests.
LEARNING TIP! Racial disparity in the judgment of pain has been studied as an example of implicit bias in healthcare.
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