Implicit Bias and its Harm in the Medical Field

Written by Elizabeth Montoya and Edited by Josephine Chan

Implicit bias refers to implicit stereotypes and prejudices, which can lead to biased judgment behavior that occurs subconsciously and may be hard to detect [1]. Research on implicit bias began in 1995 when Russell Fazio performed an experiment with “sequential priming,” in which subjects’ reactions to stereotypic words and social group labels were observed [2]. Implicit bias exists in everyday life in our interactions with one another. Studies have revealed implicit biases against different racial groups, genders, the LGBTQ+ community, and other marginalized groups, as well as within an individual’s own group. Nonetheless, the common theme is that individuals tend to favor positive stereotypes and disfavor negative stereotypes about their groups [3]. Despite claims of an objective field, the question stands of whether or not implicit bias exists in a medical field, where lives are at stake.

In the United States, those who are most greatly affected by implicit bias in the medical field are marginalized and underprivileged groups, including but not limited to the poor, mentally ill, overweight, and disabled [4]. For instance, some doctors may be less likely to recommend pain medication for black patients than white patients with an identical injury [3]. One study compared the prescriptions of black patients and white patients, and found that only 57% of black patients received pain medication compared to 74% of white patients despite self-reporting similar levels of pain [5].

In medicine, the most critical interaction is between healthcare workers and the patient, where the relationship must be stable, and an imbalance in power can make patients feel unwelcome. In one study focusing on healthcare providers, found that those most affected by these interpersonal interactions were the poorly-educated, who were subjected to unanswered questions and impersonal treatment from their healthcare providers [6]. As such, professionals that express implicit bias tend to provide less support and spend less time with these patients. As a result, these patients may not feel confident speaking up and may even distrust treatment plans [7]. As well, individuals who are from different backgrounds than their healthcare providers, in terms of class and race, tend to find communication to be more difficult [8].

Implicit bias is a difficult problem to solve, but medical institutions are working to create a curriculum to combat it. Between 2014-2015, a survey of 250 medical students examined their knowledge and implicit biases. By the end, 84% were able to acknowledge their implicit biases and why it was important to be aware of these tendencies [9]. In acknowledging these biases, individuals can work away from them by reevaluating one’s mindset and consider if something has evidence to be true. Other methods for those in the medical field include placing yourself in the patient’s shoes and seeing them as an individual rather than a stereotype, as well as to really cultivate a relationship with patients [10].

Implicit bias is a systemic issue, and it is important to hold ourselves accountable toward our own biases. Individuals can take the Harvard Project Implicit test, in which they can access their implicit bias and gain insight [10].

References:

1. Fitzgerald, C., Martin, A., Berner, D., Hurst. S. (2019). Interventions designed to reduce implicit prejudices and implicit stereotypes in real-world contexts: a systematic review. BMC Psychology, 7: 1-12.
2. Stanford Encyclopedia of Philosophy. “Implicit Bias”. The Metaphysics Research Lab, Center for the Study of Language and Information, (2019), https://plato.stanford.edu/entries/implicit-bias/.
3. “Implicit Bias”. Ethics Unwrapped, McCombs School of Business – The University of Texas at Austin, (2020). https://ethicsunwrapped.utexas.edu/video/implicit-bias.
4. Fitzgerald, C., Hurst. S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 18:1-18.
5. Hoffman, K. M., Trawalter, S., Axt, J. R., Oliver, M. N.(2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America, 113(16), 4296–4301.
6. Cockerham, W.C. Medical Sociology. New York. Routledge. 2017. p. 226, 244-245.
7. American Psychological Association. “How does implicit bias by physicians affect patients’ health care?”. American Psychological Association,(2019). https://www.apa.org/monitor/2019/03/ce-corner.
8. Motzkus, C., Wells, R. J., Wang, X., Chimienti, S., Plummer, D., Sabin, J., Allison, J ., and Cashman, S. (2019). Pre-clinical medical student reflections on implicit bias: Implications for learning and teaching. PLOS ONE. 14(11)
9. IHI Multimedia Team. “How to Reduce Implicit Bias”. Institute for Healthcare Improvement, (2017), http://www.ihi.org/communities/blogs/how-to-reduce-implicit-bias.
10. “Project Implicit.” Harvard University. 2011.