133 Evidence Based Implicit Bias Implications for Physicians and Healthcare Professionals
CASE STUDY EXERCISE 2
John is a White nurse caring for an African American pregnant woman in an obstetrics unit in a hospital. The patient is a lesbian and had an in vitro fertilization. Her partner is White and asks to speak to you, the physician, in private and not in the patient’s room. The partner mentions that she recently saw a news story about how African American women are treated unfairly in comparison to White women.
You’re sure that her partner will be given the same level of care as other patients, and you give this reassurance consciously in a deliberate manner. However, you know that, in addition to this conscious process, there are potential areas of implicit bias that might occur,both in decision making and in communication. Question 1 : How might the racial difference between the nurse, John, and the patient influence provider-patient communication? Commentary on question 1 : Given the history of racism in America, racial discordance between provider and patient may negatively impact trust in the clinical encounter. African American patients may have experienced racial insensitivities, bias, or discrimination in the past and may be vigilant for signs of caring and trust from the provider. In addition to racial implicit bias, there can be implicit bias based on other characteristics, such as sexual orientation. Question 2 : How might implicit bias show up in this case? Commentary on question 2 : 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 et al., 2019).
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