National Nursing Ebook Continuing Education Summaries

Evidence Based Implicit Bias Implications for Physicians and Healthcare Professionals

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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. ACCELERATING IMPLICIT BIAS

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 complete- ly 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 fol- lowing (Di Brito et al., 2019; “Eight Tac- tics,” 2020; IHI Multimedia Team, 2019; Narayan, 2019): Increasing knowledge It is useful for workshops and presenta- tions to describe how implicit bias devel- ops and its relationship to societal stereo- types (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 stud- ies can help providers apply knowledge to realistic, complex situations. Refresher experiences are also useful.

Given the rapid, unconscious asso- ciations that characterize implicit bias, factors that impede the slow, careful re- fection 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. 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).

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