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Implicit Bias in Health Care

Implicit bias quizAs Minnesota health care organizations work to provide culturally-competent care, many are recognizing the need to address implicit bias – also called unconscious bias. All people have implicit bias. These positive or negative attitudes or stereotypes affect our understanding, actions, and decisions in an unconscious way. In health care, this can result in unequal care.

Hidden bias, unintended differences in health care delivery

Numerous studies show that health care professionals are prone to engaging implicit biases. Even the most well-intentioned clinician may unknowingly alter their approach to a patient because of hidden biases. This can impact provider-patient interactions. Clinicians may provide the same information on treatment choices, risks, and outcomes, but their nonverbal cues may counter efforts to display empathy or build rapport.

Watch for these signs of nonverbal bias:

  • Less time touching patient
  • More time looking at the nurse or the monitor
  • Arms crossed or hands in pockets
  • Standing further away from a patient in bed.

A 2015 study in the American Journal of Public Health found that physicians with high levels of pro-white bias were 23 percent more likely to dominate the conversation and engaged in 33 percent less patient-centered communication with Black patients than with white patients. This behavior led Black patients to perceive less respect from their physician, which could influence their likelihood of following through with treatment plans and medication prescriptions.

Implicit bias also has been shown to influence clinical decision-making, contributing to variations in the treatment of pain, cancer, and heart problems. In a 2007 study linking implicit biases with the treatment of acute coronary symptoms, researchers found that found that the stronger the physicians’ pro-white biases, the more likely they were to treat white patients with life-saving thrombolysis as opposed to similarly situated Black patients.

Hidden bias, unintended health impact

Studies have shown that patient behavior and decisions are impacted when they perceive bias from their clinicians. Bias can change a patient’s behavior:

  • Higher treatment dropout
  • Lower participation in screening
  • Delays in filling prescriptions 
  • Poorer perception of care quality
  • Avoidance of health care
  • Worse health

Patients also indicate lower ratings of health care quality, after perceiving bias.

Resources

The following resources explore and address implicit bias in health care. The resources can assist in your ability to address bias on both an individual and organizational level.

Implicit Bias in Health Care Quick Quiz. Answers to the 10 questions in this Culture Care Connection quiz reveal how implicit bias affects patient care. Practical tips are offered to help correct bias and provide the best care possible.

Intercultural Development Inventory (IDI) assesses intercultural competence—the capability to shift cultural perspective and appropriately adapt behavior to cultural differences and commonalities.

The Kirwan Institute for the Study of Race and Ethnicity is an interdisciplinary engaged research institute at The Ohio State University creates original research and reports on how structural racialization and implicit bias create and sustain barriers to opportunity and health.

Social Attitudes Implicit Association Test (IAT) test measures group-based preferences, stereotypes, and identities that may not be accessible to conscious awareness.

What Is Bias, and What Can Medical Professionals Do to Address It? In this Institute for Healthcare Improvement video, Anurag Gupta, MPhil, JD, explains implicit or unconscious bias and how health care providers and others can stop it from negatively affecting people.