Implicit and explicit biases are among many factors that contribute to disparities in health and healthcare. Implicit bias involves associations outside conscious awareness that lead to a negative evaluation of a person, on the basis of irrelevant characteristics such as race, gender, socioeconomic status, age, language, income and insurance status. Chloe Fitzgerald in BMC Med Ethics, reviewed 35 articles that demonstrated evidence of implicit bias in healthcare professionals: all studies that investigated correlations found a significant positive relationship between the level of implicit bias and lower quality of care.
“Of all forms of inequity, injustice in health care is the most shocking and inhuman.” – Martin Luther King, Jr. National Convention of the Medical Committee for Human Rights, Chicago 1966
So what other evidence do we have that implicit bias exists in healthcare?
Between October 1998 and October 2006 4.5 million Implicit Association Tests (IAT) were completed on the IAT website. The results were as follows:
- Implicit bias is pervasive
- People are often unaware of their implicit biases
- Implicit biases predict behavior
- People differ in levels of implicit bias
The seminal report from the Institute of Medicine, Crossing the Quality Chasm and Unequal Treatment, found that racial and socioeconomic inequity persists in healthcare. Unequal Treatment found that even with the same insurance and socioeconomic status, and when co-morbidities, stage of presentation and other confounders are controlled for, minorities often receive a lower quality of healthcare than do their white counterparts. These health inequalities are health differences that are not only unnecessary and avoidable but in addition are considered unfair and unjust.
So what is the impact of implicit bias in healthcare?
Implicit bias affects all levels of the healthcare delivery system. Because of the research conducted, we know that the impacts of implicit bias are vast and startling:
- Non-white patients receive fewer cardiovascular interventions and few renal transplants
- Black women are more likely to die after being diagnosed with breast cancer
- Non-white patients are less likely to be prescribed pain medications (non-narcotic and narcotic)
- Black men are less likely to receive chemotherapy and radiation therapy for prostate cancer and more likely to have testicles removed
- Patients of color are more likely to be blamed for being too passive about their healthcare
What can we do as individuals to combat implicit bias?
As healthcare professionals, we must collectively work to combat implicit bias in all levels of care delivery. Here are some actions to take:
- Have a basic understanding of the cultures from which your patients come
- Avoid stereotyping your patients; individuate them
- Understand the impact and respect the magnitude of implicit bias
- Recognize situations that magnify stereotyping and bias
- Perform Teach Back
- Assiduously practicing evidence-based medicine
What can healthcare organizations do to combat implicit bias?
The research, clinical outcomes and continued racial disparities in healthcare all point to the need to eliminate the harm caused by implicit bias. Our families, friends, colleagues and community are depending on all of us to do this work. It is my hope that by providing a few suggestions, we can collectively work to eradicate the impact of implicit bias to our patients.
TeamHealth is committed to:
- Evaluate the racial climate by evaluating employees’ shared perceptions of the policies and practices that communicate the extent to which fostering diversity and elimination of discrimination is a priority. I am proud to say that here at TeamHealth, we do this under the leadership of Dr. Stanley Thompson, Chief Diversity Officer and Chief Clinical Officer of LifePoint, with DEI work and as direct statements from our senior leaders. This is an institutional priority.
- Investigate reports of subtle or overt discrimination and unfair treatment.
- Implement work policies and clinical procedures that protect clinicians from high cognitive load and promote positive emotions.
- Promote racial diversity at all levels of the company.
- Implement and evaluate training that ensures that clinicians have the knowledge and skills needed to prevent racial biases from affecting the quality of care they provide.
Eliminating Implicit Bias in Healthcare
At TeamHealth, we are committed to promoting diversity, equity and inclusion in all that we do. Learn more about our commitments to DEI and improving the medical field through elimination of implicit bias and increasing diversity in healthcare.