In the United States, people who are racial and ethnic minorities experience higher rates of morbidity and mortality on average. 7 Though they may not align with providers’ explicit beliefs, these implicit biases can potentially impact health outcomes and further contribute to health disparities. 6 Implicit bias may cause providers to unintentionally make assumptions about their patients based on stereotypes, such as having a lower expectation for patients to comply with medication regimens or assuming a patient is exaggerating symptoms based on their socioeconomic status or racial/ethnic background. 4, 5 This is especially relevant in medicine, where health care providers are subjected to fatigue, time constraints, and information overloads these circumstances make physicians highly dependent on mental short-cuts, leading to an increased reliance on stereotypes in the clinical setting. A reliance on mental shortcuts in the latter system can result in implicit bias, especially in fast-paced environments with multiple demands that encourage rapid, automatic decision-making. While one system is primarily responsible for making slow, careful, controlled, rational cognitive decisions, the other aids in automatic, effortless, associative decision-making. According to dual-process decision making theories, people have two systems to help them make decisions. Physicians should be most concerned about how implicit biases can negatively affect clinical assessments and judgments. Why Should We Care About Implicit Bias in Medicine? In the United States, for example, someone’s unconscious bias against racial and ethnic minorities often reflects the country’s historical and cultural view that non-white persons are inferior. 2 As a result, this type of bias may affect a person’s actions even when they are unaware or may consciously not think they are biased against another group. 1Īlthough implicit bias is distinct from explicit bias, they are not mutually exclusive and can reinforce each other. These biases allow one to create unfavorable and favorable assessments without a person’s awareness or control. Implicit associations cause people to have attitudes about others based on age, gender, race/ethnicity, weight, and appearance. Implicit bias refers to the societal attitudes or stereotypes that unconsciously affect our individual understanding, actions and decisions. However, most of us are not aware of our own implicit bias, how it differs from explicit bias, and the sources of implicit bias. Implicit bias has recently gained greater attention in our current sociopolitical climate and has even entered daily discourse.
What Is Implicit Bias? Where Does It Stem From? Additionally, healthcare system leadership must prioritize implicit bias trainings for students and medical staff and make greater tangible efforts to improve workforce diversity as a debiasing strategy. Future research must rely on more than pre- and post-IAT measurements to examine the effect of these strategies on improving patient outcomes.
Implicit biases can be unlearned via debiasing strategies, but these have not been examined extensively amongst health care providers. However, existing publications have demonstrated clear associations between bias and treatment recommendations, nonverbal communication, adverse birth outcomes and provider communication styles. Limited evidence exists about the association between implicit bias and health outcomes. Some level of pro-White/anti-Black bias has been found in most systematic reviews and studies, although there are less studies on bias towards Latinx populations. There are many measures of implicit bias, but the most highly regarded tool is the Implicit Association Test (IAT), as it is valid and reliable. Immigrant populations are particularly at risk in our present-day environment, and as a result experience limited healthcare access and higher levels of psychological distress. Implicit bias is the process of unconscious societal attitudes affecting our individual understanding, actions and decisions, thus leading to assumptions about groups. It is an area that has been largely explored in the social sciences, and was highlighted in the landmark 2003 IOM report, Unequal Treatment, as a contributor to racial/ethnic health disparities. Implicit bias has entered modern discourse as a result of our current sociopolitical climate.
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