Dating from the ancient origins of the Hippocratic Oath, the medical profession has publicly espoused values and ideals that consistently reaffirm its altruistic nature. Indeed, few other professions rival the field of health care in their concern for the well-being of others.
This noble and selfless profession nevertheless is not immune to its challenges. Among those that frequently permeate the news are disparities in care, which often manifest along racial and ethnic lines in which patients of color receive lower quality care than their White counterparts. Among the landmark field-shaping documents that highlighted this reality was the 2002 Institute of Medicine (IoM) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which extensively detailed these disparities.
How can we make sense of this contrast between an altruistic profession devoted to others’ well-being and the reality that the individuals comprising those “others” can receive care that hinges on their identity? As the Institute of Medicine report explored, many interrelated explanations exist that reflect a tremendous range of societal dynamics and conditions. Among these key issues are access to care and how health care systems operate; other scholars have considered the long-term nature of these challenges, such as how the historical legacy of real estate trends can have an impact on modern-day health equity issues.
Beyond the acknowledgement of these structural forces, the IoM report also contended that “some evidence suggests that bias, prejudice, and stereotyping on the part of healthcare providers may contribute to differences in care.” Supporting this assertion, a burgeoning body of academic literature has examined the role that implicit bias may be playing to perpetuate health care disparities in spite of clinicians’ egalitarian intentions.
Implicit bias refers to those attitudes and stereotypes that affect our understanding, actions, and decisions in an unconscious manner.
Also regarded as “blind spots,” implicit biases can create gaps between good intentions and good outcomes in the health care field. Although these cognitive forces are operating unconsciously, the on-the-ground impacts remain significant, with effects ranging from dynamics in medical education to interpersonal interactions between clinicians and patients to patient care outcomes. Moreover, these effects span the health profession quite broadly; as one Physician Assistant noted, “Of the four principles of bioethics, three—autonomy, non-maleficence, and justice—are most directly impacted by implicit bias.”[1]
Implicit biases can operate in numerous realms (e.g., criminal justice, education, employment); thus, the challenges of these unconscious dynamics are not specific to any particular profession. Nevertheless, several aspects of how the health care system and interactions within it operate can make clinicians particularly susceptible to the influence of implicit bias. For example, research suggests that we are more likely to rely on our implicit associations when we are under time pressures, have a high cognitive load (i.e., we have a lot on our minds at once), and when situations are ambiguous (i.e., we lack complete information), all of which are common circumstances health care providers encounter. [2, 3] Recognizing these challenges, several prominent institutions have focused on highlighting how implicit biases can operate in the health realm, most notably the Association of American Medical Colleges (AAMC)’s whom the Kirwan Institute collaborated with for the creation of a comprehensive report on unconscious bias in academic medicine.
The goal of this website:
The Kirwan Institute has created this website to help practitioners consider the concept of implicit bias and explore its operation in your field. Beginning first with the topic of health care, the materials focus on two specific areas: clinical education and patient care. The guidance offered creates an opportunity for health care professionals operating in these areas to consider their own biases and the circumstances in which they may unknowingly rely on their implicit biases. The questions in each section are not intended for institutional evaluation or monitoring; rather, they were designed for personal use to promote individual reflection.
References:
[1] Anderson, J. Should PAs Assess and Address the Impact of Implicit Bias on Patient Care? Journal of the American Academy of Physician Assistants, 2012.
[2] Burgess, D.J., Are Providers More Likely to Contribute to Healthcare Disparities Under High Levels of Cognitive Load? How Features of the Healthcare Setting May Lead to Biases in Medical Decision Making. Medical Decision Making, 2010. 30(2): p. 246-257.
[3] Bertrand, M., D. Chugh, and S. Mullainathan, Implicit Discrimination. The American Economic Review, 2005. 95(2): p. 94-98