January 16, 2013 by Brenda Buescher
“Consider the example of an implicitly biased physician who wrongly perceives that an African American patient with uncontrolled hypertension is uncooperative and unlikely to adhere to a more intensive treatment regimen. Unaware of the distortions introduced by bias, the physician may not intensify treatment appropriately. Furthermore, the physician may demonstrate bias in unconsciously negative behavior, making the patient uncomfortable and hesitant to engage in honest dialogue.”
The public health problem: Americans who belong to ethnic/racial minority groups receive worse health care and have worse health outcomes than whites, partially because of bias among healthcare providers. While explicit bias has become socially unacceptable in general American society, implicit bias (an unconscious and unintentional process that affects perceptions and behavior) is widespread.
The study participants: 210 primary care providers (family medicine and internal medicine) and 190 clinic patients in metropolitan Denver, Colorado
The study hypotheses:
1) Primary care providers will demonstrate a substantial level of implicit bias against Latinos and against African-Americans.
2) But the providers will show little explicit bias against either group.
3) And bias among the providers will be similar to bias demonstrated by other members of the community.
What they did: The researchers recruited primary care providers (60% response rate) and community members (51% response rate) from three different types of healthcare clinics: a safety net clinic, an HMO clinic, and a traditional private practice. Participants reported their general feelings about each racial group and their evaluations of the group’s specific traits (like wisdom, cooperativeness, laziness) to test their explicit bias. For implicit bias, the participants completed an Implicit Association Test. The IAT is commonly used in psychological studies. In a nutshell, it asks you to categorize things, and it measures how quickly you can do so to determine the unconscious associations your brain makes between things. (In this case, it’s measuring how easily you associate white/black/Latino people with good/bad things.)
What they found: “There was a wide range of implicit biases among both the PCPs [primary care providers] and the CMs [community members], including greater positivity toward each minority group than toward Whites. However, as hypothesized, the more frequent and stronger response was greater positivity toward Whites (i.e., bias against the minority groups).” Approximately two-thirds of the healthcare providers demonstrated implicit bias against the minority groups, even though the showed little explicit bias against either group, and the healthcare providers’ biases were similar to the biases of the broader community.
What it means: This study confirms past studies about implicit bias against African Americans and provides new evidence that implicit bias against Latinos is also common. But Blair et al. take an optimistic view. Noting that 18% of the providers showed no implicit bias regarding Latinos and 28% showed no implicit bias regarding African-Americans, they suggest that “instead of focusing on what biased providers might be doing wrong, it might be more productive to consider what this select group of providers is doing right.” Especially because providers show such little explicit bias, the authors argue, making rational arguments about the importance of cultural sensitivity might not get us very far in eliminating disparities.