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The lives of our patients are affected by bias. It plays a role in how we interpret important clues in the history and physical examination of patients, how we interpret tests, and how we convey information. If your unconscious bias is such that you downplay or discount certain facts or findings, this has the potential to negatively affect patient care (eg, missed myocardial infarction, reduced analgesic treatment, longer wait times, etc.).
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ACEP Now: Vol 36 – No 04 – April 2017What can we do? First, recognize and accept that we have biases. They help us to function and serve to protect us. It is a necessary part of who we are as humans. Reflect on our biases, developing the capacity to shine the light on ourselves. Research has demonstrated that bias blind spots (the ability to “rationally” explain away our biases) are greater in those with higher cognitive ability (eg, physicians). Realize that this is not easy to deal with. Explore the awkwardness and discomfort that comes along with examining our biases and how it affects our daily interactions. Engage with people who we consider “others” and learn and gain experience from them. Finally, get feedback. Ask a trusted person, “How did I do?” This is how we learned our profession. We became educated, sought guidance and feedback, and practiced it over and over.
Dr. Lopez is professor and vice chair in the department of emergency medicine at Thomas Jefferson University Hospital, associate provost for diversity and inclusion at Thomas Jefferson University, and associate dean for diversity and community engagement at Sidney Kimmel Medical College of Thomas Jefferson University, all in Philadelphia.
References
- Greenwald AG, McGhee DE, Schwartz JL. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74(6):1464-1480.
- About the IAT. Project Implicit website. Accessed March 13, 2017.
- Green AR, Carney DR, Palin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231-1238.
- Cooper LA, Roter DL, Carson KA, et al. The associations of clinicians’ implicit bias attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;102(5):979-987.
- Schwartz MB, Chambliss HO, Brownell KD, et al. Weight bias among health professionals specializing in obesity. Obes Res. 2003;11(9):1033-1039.
- Uncapher H, Arean PA. Physicians are less willing to treat suicidal ideation in older patients. J Am Geriatr Soc. 2000;48(2)188-192.
- Popa-Roch M, Delmas F. Prejudice Implicit Association Test effects – the role of self-related heuristics. J Psychol. 2010;218(1):44-50.
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3 Responses to “How Does Bias Affect Physicians, Patients?”
April 15, 2017
Mark BuettnerThe IAT does not predict behavior of racial bias whatsoever. Is credible science not important anymore? The bias here is “Bandwagon Bias”. Perhaps we should pause before jumping on board.
It’s hard to disagree with the conclusion of Fiedler and his colleagues that it is only “fair and appropriate to treat the IAT with the same scrutiny and scientific rigour as other diagnostic procedures.” If that’s true, then between Project Implicit and cutting-edge diversity trainings, the IAT has misled potentially millions of people. Over and over and over and over, the IAT, a test whose results don’t really mean anything for an individual test-taker, has induced strong emotional responses from people who are told that it is measuring something deep and important in them. This is exactly what the norms of psychology are supposed to protect test subjects against.
May 19, 2017
Bernard L. Lopez, MD, MS, CPE, FACEP, FAAEMIn my article, I never said that the IAT predicts behavior of racial bias. Much research has been done on the IAT since it was first described. Thus, the test has undergone significant scientific scrutiny and raises questions on just exactly what it measures. One school of thought is that the IAT may simply be measuring the association of positive evaluations with the “in” or majority group and negative evaluations with the “out” or minority group and that it may not be a specific attribute effect but rather the manner in which humans behave. In my article, I describe a study that suggests that in-group/out-group membership, and not nationality, was the important factor.
Too often, people are told to take the test on their own. Therein lies the potential harm—they read the results and may assume that they are prejudiced against a group. The test may also be used by diversity educators who may suggest the existence of prejudice. In this regard, I agree with Dr. Buettner that the IAT is misleading. In my article, I gave the opinion that the IAT is a tool that can be used to stimulate thought about one’s unconscious biases but should NOT be used to measure one’s “prejudices.” Having a strong preference for a certain group does not mean that one is prejudiced against another. Knowledge of this preference is useful when dealing with someone from “the other” group as it allows you to consider how your bias may affect certain behaviors and decisions. The use of the IAT needs to be done in a controlled setting that stresses the fact that it does not measure prejudice and that it should simply stimulate thought about one’s unconscious biases.
I disagree with Dr. Buettner’s statement that the IAT is a test whose results don’t really mean anything for an individual test-taker. For the individual, the results suggest a preference. This preference, when used to stimulate thought (not measure prejudice) on potential biases, can be valuable in future interpersonal interactions.
Bernard L. Lopez, MD, MS, CPE, FACEP, FAAEM
June 2, 2017
Mark BuettnerPoint of Clarification: The opening sentence of my original response should read as follows: The IAT does not predict behavior OR racial bias whatsoever.
Mark F. Buettner DO, FACEP, FAAEM