Question 2 How might implicit bias show up in this case? Commentary on question 2
There is abundant evidence that even when controlling for variables such as insurance,socioeconomic status, and geography, implicit bias is an important influence on patient satisfaction and referral for treatment, both contributors to healthcare disparities (Saluja &Bryant, 2020; Wilson et al., 2021). Even high-status African American patients can experience disparate treatment. When giving birth, tennis star Serena Williams suffered a pulmonary embolism. Although thankful for the care she received, she noted that her status likely contributed to her getting a level of care not afforded to all African American women (Salam, 2018). Ms. Williams’ experience causes some to reflect on the 2019 CDC report that indicated a racial disparity in pregnancy-related deaths. Implicit bias can not only influence the assessment of pain but can also influence provider decision making in high-discretion situations (Johnson et al., 2019; Roeder, 2018). For example, of the two or three tests that might be available for a particular condition, there is sometimes discretion on the part of the provider in terms of which test is given or how soon a test is recommended. While consciously endorsing values of equity, fairness, high quality care, etc., provider behavior can be influenced by implicit bias.
Given that there might be a difference between conscious attempts to be fair and equitable and implicit bias, care needs to be taken to ensure that word choice and nonverbal communication (eye contact, smiling, etc.) do not reflect unintentional bias. Self-reflection and awareness can be useful tools. Reflecting on the question, " Would I react differently if the patient was White or heterosexual?" can be a useful strategy. The quality of communication is also related to word choice. One hundred and seventeen videotaped racially discordant physician-patient encounters were analyzed using the Linguistic Inquiry and Word Count software. Providers with higher levels of implicit racial bias(based on IAT scores) more frequently used first-person pronouns and anxiety-related words than providers with lower implicit racial bias scores (Hagiwara et al., 2016). Communication is also a major factor in a patient’s experience of trust in the clinical encounter (Cuevas etal., 2019).
ACCELERATING IMPLICIT BIAS
Given the rapid, unconscious associations that characterize implicit bias, factors that impede the slow, careful refection of multiple factors can be fertile ground for implicit bias. Many providers may see these factors as basically describing their day-to-day work. But recognizing these factors can provide an opportunity to try to make small modifications, where possible, to mitigate the influence of implicit bias. (Johnson et al., 2016) Mitigating implicit bias There are several strategies that have shown promise in mitigating or reducing the occurrence of implicit bias. Given the brain’s innate rapid processing of large amounts of data every second and the acceleration factors mentioned above, there is no strategy that can completely eliminate unconscious associations or bias. Further, approaches to mitigating or reducing implicit bias are most effective when more than one strategy is utilized. Strategies to consider include the following (Di Brito et al., 2019; “Eight Tactics,”2020; IHI Multimedia Team, It is useful for workshops and presentations to describe how implicit bias develops and its relationship to societal stereotypes (race, gender, sexual orientation, disability, etc.).Presentation of research findings can help providers understand how implicit bias can negatively impact various aspects of the clinical encounter and contribute to healthcare disparities. As a component of workshops, case studies can help providers apply knowledge to realistic, complex situations. Refresher experiences With knowledge of the development and process of implicit bias as a foundation, a pause-and-reflect approach can increase the occasions when providers deliberately take a few moments to reflect on their thoughts and behaviors when interacting with a patient and/or making an important decision. Pausing allows for a few seconds to reflect on the kinds of associations that they may be making as the patient walks through the door based on the way they’re dressed, their gender, their race, Disparities in access to and delivery of healthcare services As it is quite apparent that disparities in healthcare exist, The Department of Health and Human Services intends to directly address this inequality by 2026. It has posted a draft of its strategic goals for the fiscal years 2022-2026, and impartial access to healthcare is of particular interest. The first of the five stated goals is to “Protect and Strengthen Equitable Access to High Quality and Affordable Healthcare” (HHS.gov, 2021a). 2019; Narayan, 2019): Increasing knowledge are also useful. Self-awareness
Quick Implicit Bias Facts Several factors can accelerate implicit bias or make it more likely to be a significant influence: ● Time constraints (e.g., limited time to see a patient). ● Complexity (e.g., multitasking or needing to consider multiple factors quickly). ● Physical constraints (e.g., working long hours). or any other characteristic. Discovering personal tendencies or becoming aware of an area of personal bias can help in modifying communication, where necessary. Such self-awareness can prompt providers to focus on seeing a given patient as an individual (individuation) and trying to see things from the Implicit bias can play a key role in fostering and reinforcing systems of inequities in hiring and promotion. Race, gender, accent, weight, etc. are factors that not only impact implicit bias in patient care but can also influence hiring and promotion decisions. Mitigating unconscious bias in rewards and recognition, as well as in selection decisions, is of critical importance in the work to increase the diversity of medical students, clinical providers,researchers, managers, and senior Information about implicit bias as well as motivation to reflect on personal biases can begin to fade months and even weeks after the initial intervention. Strategies to stimulate recall or remind providers about the work to mitigate implicit bias can be useful. Key words or phrases on the treatment room computer screen or even a specially designed screen saver can be used as a reminder. A mobile phone background can contain a photo or a word that serves as a reminder every time the provider uses the phone. Changing the photo or word periodically can help to avoid habituation. The inside cover of a folder containing CVs can list key phrases to remind search committee members to avoid bias in the screening process. patient’s perspective (perspective taking). Organization systems and processes healthcare providers. Cues and reminders As part of this goal,one strategic objective specifies an intent to “expand equitable access to comprehensive,community- based, innovative, and culturally-competent healthcare services while addressing social determinants of health”. They describe improved access to health-related services for an underserved population through the removal of barriers to access, a reduction in disparities in healthcare, and support of community-based
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