Implicit bias: the importance of self-awareness for patient care and in the workplace

MGMA Stat - January 10, 2019

Human Resources

Quality & Patient Experience


The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders if their organization has addressed implicit (subconscious) bias. Overall, 17% of respondents indicated that “yes,” they had, 49% had not, 8% were unsure and the remaining 26% did not know what implicit (subconscious) bias is.

Among the most frequent responses from respondents regarding what their organization has done are providing awareness education, training to understand implicit and explicit bias, developed polices and encouraged self-awareness. This is often done on an annual basis in group training and discussions, video or web-based courses, articles, forums or staff retreats. This poll was conducted on January 8, 2019, with 967 responses.

“…the patient has his or her own moral, ethical, and legal right to expect compassionate care that is not compromised, consciously or unconsciously, by harmful human biases on the part of the clinician.”
                                                                                                WHITE AND STUBBLEFIELD-TAVE, 2016

Implicit bias refers to the attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner. These biases, which can be positive and negative, are activated involuntarily and without awareness or intentional control. Implicit associations are part of our subconscious and cause us to have feelings and attitudes about other people based on characteristics such as race, ethnicity, age and appearance. These associations develop over the course of a lifetime and are formed at a very early age through exposure to people, experiences and media.

Implicit bias affects healthcare decisions in many ways. The most obvious is in the care of patients. Evidence indicates that biases are likely to influence diagnosis and treatment decisions as well as appropriate levels of care in some circumstances. In addition to affecting judgments, implicit biases manifest in our non-verbal behavior toward patients and families, such as frequency of eye contact and physical proximity. Examples of a few well-documented implicit biases in healthcare include:
  • White male physicians are less likely to prescribe pain medication to black patients than to white patients.1
  • Providers assume their low-income patients are less intelligent, more likely to engage in risky behaviors and less likely to follow medical advice. 1
  • Pregnant women face discrimination from healthcare providers on the basis of their ethnicity and socioeconomic background. 2
  • Women presenting with coronary heart disease (CHD) symptoms are significantly less likely than men to receive diagnosis, referral and treatment, due to misdiagnosis of stress/anxiety.3
According to a recent MGMA Connection article by Joy Stephenson-Laws, JD, 
many healthcare providers do not exhibit any type of racial bias in their routine, day-to-day interactions with patients but rather their biases seem to be “triggered” when they are busy, distracted, tired or under pressure. Unfortunately, many healthcare providers increasingly find themselves in these types of situations. In some settings, such as trauma care, it is the norm. This can lead to a healthcare provider assuming that a black patient reporting pain is drug-seeking rather than pain-relief-seeking or that a non-white adolescent will not follow through with safe sex guidelines and therefore should not be given counseling or sexually transmitted infection prophylaxis.

Implicit bias is also seen in the healthcare workplace as it relates to employees, providers and care teams. It affects everything from recruitment and retention to promotion and development. On the positive side, literature has shown that with greater gender, ethnic and cultural diversity within teams and workplaces comes better financial performance. A 2018 report from McKinsey & Company revealed that, "Gender, ethnic, and cultural diversity, particularly within executive teams, continue to be correlated to financial performance across multiple countries worldwide." Moreover, diversity enhances creativity and leads to more innovative and connected workplaces.

Mitigating implicit bias in healthcare starts with awareness. By taking the Implicit Association Test (IAT) and regularly reflecting on one’s biases and decision-making, we can better recognize it. The IAT brings unconscious associations to conscious awareness, which is crucial in making individuals more self-aware of their biases. Regular reflection, which can be done individually or in group settings, is an exercise in personal growth and can also lead to greater empathy, openness and vulnerability among colleagues and caregivers. With inclusive training, processes and awareness tools, we can make healthcare better for all our patients and our care teams.

MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. See results of other polls and information on how to participate in MGMA Stat.

Resources:

References:
  1. “Not me! Doctors, Decisions, and Disparities in Health Care.” Medscape. Accessed Jan. 10, 2019. Available from: bit.ly/2H5KS2P
  2. McDonald, K and Ramm, N. “Addressing Disparities in the U.S. for Maternal Health and Rights.” Maternal Health Task Force. Accessed Jan. 10, 2019. Available from: bit.ly/2VHReJ9
  3. “Study reveals that signs of heart disease are attributed to stress more frequently in women than men.” Cardiovascular Research Foundation. Accessed Jan. 10, 2019. Available from: bit.ly/2AEow2J
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Katie Richardson, MD
Pediatrician and healthcare leader
Colorado Permanente Medical Group (CPMG)
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