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The Inconvenient Truth About Unconscious Bias in the Health Professions

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Diversity and Inclusion in Quality Patient Care

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Abstract

More than 15 years after two pivotal reports from the Institute of Medicine (now the National Academy of Medicine) focused their attention on unequal access to healthcare and established health equity as a pillar of quality care, healthcare disparities persist. Some of this can be traced to overt discrimination against certain groups, but this chapter shines a light on a subtler form of prejudice: unconscious bias. The by-product of a normal—and often useful—human tendency to make associations and split-second judgements, unconscious bias, affects even people who believe strongly in equality and equal care. Left unaddressed, unconscious bias can influence relationships between providers and patients and among providers and their colleagues, affecting clinical interactions, workplace diversity, and even patient outcomes. Providers can mitigate unconscious biases by becoming more aware of them and resolving to overcome them through proven strategies for improving health equity and reversing health disparities.

“ Not everything that is faced can be changed, but nothing can be changed until it is faced. ” – James Baldwin

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References

  1. Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment: confronting ethnic and racial disparities in health care. Washington: National Academies Press; 2003. 780 p.

    Google Scholar 

  2. Smedley BD, Butler AS, Bristow LR, editors. In the nation’s compelling interest: ensuring diversity in the health-care workforce. Washington: National Academies Press; 2004. 429 p.

    Google Scholar 

  3. Hall WJ, Chapman MV, Lee KM. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105(12):e60–76.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Matthew DB. Just medicine: a cure for racial inequality in American health care. New York: New York University Press; 2015.

    Google Scholar 

  5. White AA. Diagnosis and treatment: the subconscious at work. In: Seeing patients: unconscious bias in health care. Cambridge: Harvard University Press; 2011. p. 199–210.

    Chapter  Google Scholar 

  6. United States Department of Justice. Understanding bias: a resource guide [Internet]. Washington: U.S. Department of Justice; 2016. (Cited Nov 29 2017). Available from: https://www.justice.gov/crs/file/836431/download

  7. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27(3):759–69.

    Article  Google Scholar 

  8. Lewis D, Paulsen E, editors. Proceedings of the diversity and inclusion innovation forum: unconscious bias in academic medicine. How the prejudices we don’t know we have affect medical education, medical careers, and patient health. Washington: Association of American Medical Colleges; 2017. 105 p.

    Google Scholar 

  9. Schulman KA, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340(8):618–26.

    Article  CAS  PubMed  Google Scholar 

  10. Schulman KA, et al. The roles of race and socioeconomic factors in health services research. Health Serv Res. 1995;30(1.2):179–95.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Green AR, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pololi LH, et al. The experience of minority faculty who are underrepresented in medicine at 26 representative U.S. medical schools. Acad Med. 2013;88(9):1–7.

    Article  Google Scholar 

  13. Palepu A, et al. Minority faculty and academic rank in medicine. JAMA. 1998;280(9):767–71.

    Article  CAS  PubMed  Google Scholar 

  14. Banaji MR, Greenwald AG. Blindspot: hidden biases of good people. New York: Delacorte Press; 2013. 272 p.

    Google Scholar 

  15. Ross HJ. Everyday bias. Lanham: Rowman & Littlefield; 2014. 207 p.

    Google Scholar 

  16. Dovidio JF, et al. Disparities and distrust: the implications of psychological processes for understanding racial disparities in health and health care. Soc Sci Med. 2008;67(3):478–86.

    Article  PubMed  Google Scholar 

  17. Staat C. State of the science: implicit bias review 2014. Columbus: Kirwan Institute for the Study of Race and Ethnicity; 2014.

    Google Scholar 

  18. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;18(19):1–18. https://doi.org/10.1186/s12910-017-0179-8.

    Article  Google Scholar 

  19. Burgess DJ, et al. Understanding the provider contribution to race/ethnicity disparities in pain treatment: insights from dual process models of stereotyping. Pain Med. 2006;7(2):119–34.

    Article  PubMed  Google Scholar 

  20. Johnson TJ, et al. The impact of cognitive stressors in the emergency department on physician implicit racial Bias. Acad Emerg Med. 2016;23:297–305.

    Article  PubMed  PubMed Central  Google Scholar 

  21. The Joint Commission. Implicit bias in health care. Quick Safety. 2016;23:1–4.

    Google Scholar 

  22. Match communication code of conduct [Internet]. Washington, DC: National Residency Matching Program; c2017 (Cited 21 Dec 2017). Avail from: http://www.nrmp.org/communication-code-of-conduct/

  23. Elliott AM, Alexander SC, Mescher CA, Mohan D, Barnato AE. Differences in physicians’ verbal and nonverbal communication with black and white patients at the end of life. J Pain Symptom Manage. 2016;51(1):1–8. https://doi.org/10.1016/j.jpainsymman.2015.07.008.

    Article  PubMed  Google Scholar 

  24. Epps CD, Ware LJ, Packard A. Ethnic wait time differences in analgesic administration in the emergency department. Pain Manag Nurs. 2008;9(1):26–32.

    Article  PubMed  Google Scholar 

  25. Heins A, et al. Physician race/ethnicity predicts successful emergency department analgesia. J Pain. 2010;11(7):692–7.

    Article  PubMed  Google Scholar 

  26. Telfer P, et al. Management of the acute painful crisis in sickle cell disease—a re-evaluation of the use of opioids in adult patients. Br J Haematol. 2014;166(2):157–64.

    Article  CAS  PubMed  Google Scholar 

  27. Todd KH, Samaroo N, Hoffman JR. Ethnicity as a risk factor for inadequate emergency department analgesia. JAMA. 1993;269(12):1537–9.

    Article  CAS  PubMed  Google Scholar 

  28. Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296–301. https://doi.org/10.1073/pnas.1516047113.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Schaa KL, et al. Genetic counselors’ implicit racial attitudes and their relationship to communication. Health Psychol. 2015;34(2):111–9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Teal CR, Gill AC, Green AR, Crandall S. Helping medical learners recognise and manage unconscious bias toward certain patient groups. Med Educ. 2012;46(1):80–8. https://doi.org/10.1111/j.1365-2923.2011.04101.x.

    Article  PubMed  Google Scholar 

  31. Teal CR, Shada RE, Gill AC, Thompson BM, Fruge E, Villarreal GB, Haidet P. When best intentions aren’t enough: helping medical students develop strategies for managing bias about patients. J Gen Intern Med. 2010;25(Suppl 2):S115–8. https://doi.org/10.1007/s11606-009-1243-y.

    Article  PubMed  Google Scholar 

  32. Greenwald AG, McGhee DE, Schwartz JLK. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74(6):1464–80.

    Article  CAS  PubMed  Google Scholar 

  33. Blair IV, et al. Assessment of biases against Latinos and African Americans among primary care providers and community members. Am J Public Health. 2013;103(1):92–8.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cooper LA, et al. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;102(5):979–87.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Oliver MN, et al. Do physicians’ implicit views of African Americans affect clinical decision making? J Am Board Fam Med. 2014;27(2):177–88.

    Article  PubMed  Google Scholar 

  36. Phelan SM, et al. Implicit and explicit weight bias in a national sample of 4,732 medical students: the medical student CHANGES study. Obesity. 2014;22(4):1201–8.

    Article  PubMed  Google Scholar 

  37. Sabin JA, et al. Physicians’ implicit and explicit attitudes about race by MD race, ethnicity, and gender. J Health Care Poor Underserved. 2009;20(3):896–913.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sabin JA, Rivara F, Greenwald AG. Physician implicit attitudes and stereotypes about race and quality of medical care. Med Care. 2008;46(7):678–85.

    Article  PubMed  Google Scholar 

  39. Sabin JA, Marini M, Nosek BA. Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS One. 2012;7(11):e48448.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Hoever IJ, van Knippenberg D, van Ginke WP, Barkema H. Fostering team creativity: perspective taking as key to unlocking diversity’s potential. J Appl Psychol. 2012;97(5):982–6.

    Article  PubMed  Google Scholar 

  41. Page SE. The difference: how the power of diversity creates better groups, firms, schools, and societies. Princeton: Princeton University Press; 2007.

    Google Scholar 

  42. Cohen JJ, Gabriel BA, Terrell C. The case for diversity in the health care workforce. Health Aff. 2002;21(5):90–102.

    Article  Google Scholar 

  43. Komaromy M, et al. The role of black and Hispanic physicians in providing health care for underserved populations. N Engl J Med. 1996;334(20):1305–10.

    Article  CAS  PubMed  Google Scholar 

  44. Sullivan LW. Missing persons: minorities in the health professions. Durham: Sullivan Commission on Diversity in the Healthcare Workforce; 2004. p. 201.

    Google Scholar 

  45. Sullivan LW, Suez Mittman I. The state of diversity in the health professions a century after Flexner. Acad Med. 2010;85(2):246–53.

    Article  PubMed  Google Scholar 

  46. Glicksman E. Unconscious bias in academic medicine: overcoming the prejudices we don’t know we have [Internet]. Washington, DC: AAMC; 2016 Jan (Cited 21 Dec 2017). Available from: https://www.aamc.org/newsroom/reporter/january2016/453944/unconscious-bias.html

  47. Capers Q IV, Clinchot D, McDougle L, Greenwald AG. Implicit racial bias in medical school admissions. Acad Med. 2017;92(3):365–9.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Diversity Policy and Programs, Organizational Capacity Building, Association of American Medical Colleges (AAMC), Washington, DC, USA

    Laura Castillo-Page

  2. Human Capital Initiatives, SHPEP, Diversity Policy and Programs, Association of American Medical Colleges, Washington, DC, USA

    Norma Iris Poll-Hunter

  3. Association of American Medical Colleges, Washington, DC, USA

    David A. Acosta

  4. Health Equity Partnerships and Programs, Diversity Policy and Programs, Association of American Medical Colleges, Washington, DC, USA

    Malika Fair

Authors
  1. Laura Castillo-Page
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  2. Norma Iris Poll-Hunter
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  3. David A. Acosta
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  4. Malika Fair
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Corresponding author

Correspondence to Laura Castillo-Page .

Editor information

Editors and Affiliations

  1. Office for Diversity and Equity and Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA

    Marcus L. Martin

  2. Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Sheryl Heron

  3. Department of Medicine, Louisiana State University, New Orleans, LA, USA

    Lisa Moreno-Walton

  4. Office for Diversity and Equity, University of Virginia, Charlottesville, VA, USA

    Michelle Strickland

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Castillo-Page, L., Poll-Hunter, N., Acosta, D.A., Fair, M. (2019). The Inconvenient Truth About Unconscious Bias in the Health Professions. In: Martin, M.L., Heron, S., Moreno-Walton, L., Strickland, M. (eds) Diversity and Inclusion in Quality Patient Care. Springer, Cham. https://doi.org/10.1007/978-3-319-92762-6_2

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  • DOI: https://doi.org/10.1007/978-3-319-92762-6_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-92761-9

  • Online ISBN: 978-3-319-92762-6

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