131 Evidence Based Implicit Bias Implications for Physicians and Healthcare Professionals
CASE STUDY EXERCISE 1
You’ve just come from a meeting with a group of African American and Latinx community residents. They presented the committee, which you are a part of, with a list of demands related to what they perceive as a racist hospital environment.
Your first patient is a 24-year-old African American male, dressed in a t-shirt and jeans. You greet him and before you can ask any questions, he asks you a few questions. “Where did you grow up?” “Did you have any Black friends?” “Why are you looking at your watch?” “Is this going to be more than a 10-minute visit?” Question 1 : Why might the community members perceive a hospital or healthcare system as being racist? Commentary on question 1 : In addition to the history and present state of a particular hospital or healthcare system, the history of racism in America in general, as well as continuing racial health disparities, may contribute to some African Americans and Latinx community residents perceiving a hospital as being racist. Question 2 : Why might some African American patients question White providers about their background and experience in working with African American 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 African American or spend significant amounts of time in predominately African American communities. Stereotypes about casually dressed young African American men may operate for some providers. As mentioned earlier, implicit bias operates not only for race, given the historical context of race in America, but gender, sexual orientation, height, weight, and even accent can unconsciously influence attitudes and decisions. In one experiment, subjects listened to two separate English speakers reading the same script. When they saw a photograph of an Asian person as the speaker, they rated the accent as being stronger than when the speaker was paired with a photo of a White person. They also rated the understanding of the content as being more difficult to understand when they saw the face of an Asian person. The assessment of the speaker, prompted by the photograph of an Asian individual, appeared to be influenced by unconscious bias (Zheng & Samuel, 2017). Before the Covid-19 pandemic, it was more common to have online courses with PowerPoint slides and videos, without seeing the actual instructor. MacNell constructed a research design where a male and a female instructor each led two sections of a discussion group. During one section they both used a male name; during the other section they both used a female name. Students couldn’t see the face of the instructor or hear their voice. They tried to teach all four sections similarly. At the end of the semester, the students in all four discussion groups were asked to rate the instructors on 12 different traits, covering characteristics related to their effectiveness and interpersonal skills. The male-named instructors were rated highest on all characteristics, regardless of whether the instructors were actually male or female. Classwork was graded and returned to students at the same time in all four sections. Students who thought that they were being taught by a male instructor gave a promptness rating of 4.35 out of 5. Student gave the female-named instructors a rating of 3.55 (MacNell et al., 2014; Mitchell & Martin, 2018). Again, this points to the powerful influence of unconscious bias.
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