Evidence-Based Implicit Bias Implications for Physicians and Healthcare Professionals: Summary 22
Healthcare Research In addition to a provider’s conscious adherence to high ethical standards and a commitment to quality care, they are also subject to implicit bias, like the rest of the population. The national interest in implicit bias in healthcare intensified when the Institute of Medicine delivered their report, Unequal Treatment , in 2003 . It concluded that implicit bias against social groups, including racial and ethnic groups, can impact the clinical encounter. Much of the research supporting this report utilized the online Implicit Association Test (IAT). The IAT measures the strength of associations between concepts such as Black or White, old or young, good or bad, desirable or undesirable, and dangerous or friendly. The reaction time (association) to various pairs of words or photographs is a measure of the strength of the association. Millions of people used this website (operated by Harvard University) to take the IAT or one of the other tests. LEARNING TIP!
CASE STUDY - EXERCISE 1 You’ve just come from a meeting with a group of Black 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 Black 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 per- ceive 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 sys- tem, the history of racism in America in general, as well as continuing racial health disparities, may contribute to some Black and Latinx community residents perceiving a hospital as being racist. Question 2: Why might some Black patients question White providers about their background and experience in working with Black pa- tients? 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 Black or spend significant amounts of time in predominantly Black communi- ties. Stereotypes about casually dressed young Black men may operate for some providers.
Racial disparity in the judgment of pain has been studied as an example of implicit bias in healthcare.
In research by Mende-Siedlecki and colleagues, White providers demonstrated more stringent thresholds in perceiving pain on Black faces versus White faces, and those with more stringent thresholds for Black patients prescribed fewer non-narcotic pain relievers. Studies about implicit bias and pain indicate that Black women are often not believed when they express their pain level
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