We have heard the terms equity and bias being used in discussions to elicit changes in board rooms and company policies. These terms also apply to healthcare as well. Bias exists in healthcare just as it does in any other industry. In understanding how bias works in health care, we can figure out how to combat it and navigate it.
Bias is the preference for or aversion to a person or group of people. Implicit bias is a term used to describe when we have attitudes towards people or associate stereotypes with them without our conscious knowledge. It comes from the messages, attitudes, and stereotypes we pick up from the world we live in. These messages can be from learning environments such as schools and also from the media. Implicit bias produces and/or reinforces negative stereotypes about others based on attributes such as their race, gender, ethnicity, and sexual orientation.
Why is this important in healthcare? It can affect how care is given and how resources are utilized. A systematic review of over 42 journal articles indicates that physicians have the same implicit bias as the general population. This evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care. Reviews showed that Black patients, regardless of the disease or illness, felt they were given less information and less time spent with them. The medical literature indicated that racial and ethnic minorities and women are subject to less accurate diagnoses, limited treatment options, less pain management, and worse clinical outcomes.
African American/ Black people make up 13% of our population. However, the number of Black physicians account for 5% of physicians nationally. This is indicating that the medical profession does not represent the population it serves. How does this affect implicit bias? African American/Black physicians have been shown to exhibit low implicit bias and neutral views regardless of the patient’s race.
Healthcare and the medical field in general often viewed bias as external factors and not relevant to the field. However, it has become clear that this has led to health disparities and poor outcomes for patients. Despite the African American/ Black community being aware of these types of treatment, it takes structured data to elicit change in the form of journal articles. The medical field (hospital systems, medical schools) is now working on testing for biases, and having individuals acknowledge their personal biases. The effect of implicit bias on health care disparities could decrease if all physicians acknowledged their susceptibility to it and deliberately practiced perspective-taking and individuation when providing patient care. This can be difficult since most physicians cannot spend the time they need to with patients due to constraints placed on them by the system. These reviews also discussed that increasing the number of African American/Black physicians could reduce implicit bias on health care disparities.
This is a case of the importance of representation. If medical schools can curtail their implicit bias in the interviewing process, that could lead to a medical workforce representing the general population. Most physicians/clinicians believe they are immune to bias because they chose this profession to care for people. Acknowledging the implicit bias is an important first step in decreasing the poor health outcomes that come along with it. It would be difficult to eliminate implicit bias, but there are ways to mitigate it. The physician-patient relationship is an important one, and when we work together, we can create the best outcome.