127 Evidence Based Implicit Bias Implications for Physicians and Healthcare Professionals
ed the belief that Africans were not fully human (Medical News Today, 2021). In the 18th and 19th centuries the support of this belief of inhumanity took the form of scientific racism or pseudo - science. Many people, both profession - als and laypersons, thought that African American people had an innate tenden- cy to want to run away from the confine - ment of the plantation, had thicker skin and skulls, and had fewer nerve endings and therefore could endure more pain. This rationale was often used for the ex- treme brutalization and whipping experi- enced by African American men, women, and children (Gilder Lerhman Institute of American History, 2021). These beliefs contributed to the medical experimenta- tion conducted on African American bod- ies, sometimes without any attempt to reduce the pain and suffering of African American patients or experimental sub- jects (Cohen, 2021; Dimuro, 2018). Although current laws, policies, and ac- cepted medical practices have eliminated the horrendous abuses of African Ameri- can bodies, it is important to recognize how deeply embedded many of the be- liefs and perceptions of African American people are within American culture, both consciously and implicitly. A 2016 study revealed that almost half of the medical students and residents surveyed endorsed notions of pseudoscience, believing that African American people had thicker skin, less sensitive nerve endings, and experi- enced less pain than Whites (Hoffman et al, 2016; Skibba, 2019). In spite of con- scious 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. Definition Implicit bias can be defined as those attitudes, beliefs, and stereotypes that affect our understanding, behavior, and actions in an unconscious (implicit) man- ner. A relatively small portion of the infor- mation the brain processes is conscious. The majority of information is processed unconsciously, out of awareness. As peo- ple process this information, their uncon- scious association can reinforce stereo- types that most often differ from their conscious assessment of an individual or group. These unconscious associations can contribute to the unequal treatment of people based on their race, ethnicity, gender, gender identity, age, disability, sexual orientation, etc. Although implicit bias and unconscious associations can be a subtle influence on cognition and be - havior, their impact on decisions can be significant (DeAngelis, 2019; Edgoose et al., 2019). California is a leader in rec- ognizing the criticality of implicit bias in healthcare (California Legislative Informa- tion, 2021).
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