MEDICAL ECONOMICS & BUSINESS OF MEDICINE
How to Identify & Address Physician Bias
by Mohammad Qureshi, MD
We are living in a time where various racial and cultural differences
in our society are being highlighted in a negative way and are being
portrayed as a cause of all that is wrong with our country. Every
day a barrage of information on news media and social media
disparages a group of people with in our society. Physicians, being
part of this society, are not immune from this either.
A systematic review by Chloe Fitzgerald published in BioMed
Central Ethics in 2017 demonstrated that healthcare professionals
exhibited the same levels of implicit bias as the wider population.
The various studies demonstrated that prejudices are likely to
influence diagnosis and treatment decisions and levels of care.
Hence as providers, our biases can have a direct consequence on
the life and wellbeing of our patients.
Medical providers can have two types of biases: one explicit and
other implicit. Explicit bias involves attitudes and beliefs that are
visible about a person or a group on a conscious level. This kind of
partiality is a result of deliberate thought and arises as the direct
result of a perceived threat. When people feel threatened, they are
more likely to draw group boundaries to distinguish themselves
from others. For example, viewing all African Americans as a threat.
President Obama identified this bias in his grandmother, who stated
that she would cross over to other side of the road if she saw an
African American walking on the sidewalk.
Implicit bias refers to the attitudes or stereotypes that affect our
understanding, actions, and decisions in an unconscious manner.
These preconceived notions, which encompass both favorable and
unfavorable assessments, are activated involuntarily and without
an individual’s awareness or intentional control. Residing deep in
the subconscious, these biases are different from known biases that
individuals may conceal for the purposes of social and/or political
correctness. Rather, implicit biases are not accessible through
introspection.
The implicit associations we harbor in our subconscious cause
us to have feelings and attitudes about other people based on
characteristics such as gender, race, ethnicity, religion, age, and
appearance. These associations develop over the course of a
lifetime beginning at a very early age through exposure to direct and
indirect messages. In addition to early life experiences, the media is
often cited as an origin of implicit associations.
Each one of us has implicit biases, even people who state that they
are culturally savvy and deny any prejudices. There is a difference
in implicit and explicit bias, but they are not totally exclusive
and sometimes they may reinforce each other. These biases are
malleable and medical provider can gradually overcome these
thoughts with some debiasing techniques.
For example, explicit biases can be confronted with the democratic
concepts that “We are all Americans” and “All men are created
equal” and “This country is a country of immigrants”. Making a
conscious effort to socially interact with individuals or groups from
different ethnicities and backgrounds can also help overcome these
bias thoughts and fears.
As mentioned earlier, each one of us has some implicit partiality.
Tools are available, such as “Project Implicit” (https://implicit.
harvard.edu/implicit/), to elucidate these subconscious biases.
“Project Implicit” is a simple online tool that can be explored
privately. Once a physician has identified their subconscious biases,
then various strategies can be used to address them. One of the
strategies that can be utilized is having a “personal timeout” to
think about preconceptions, pausing a few seconds before making
a recommendation. Would we recommend the same option to our
own loved one, our own family member?
Having an awareness of health disparities and health inequities
in certain populations allows one to approach the issue from
the patient’s perspective. Putting yourself in the patient’s shoes
is a necessary step in communication. Physicians and medical
providers have to avoid categorizing patients in specific groups and
generalizing. For example, categorizing all Native Americans as
abusing pain medicines should be considered wrong. Each patient
has to be viewed as an individual, and interventions have to be
based on her/his individual needs. Avoiding mentioning some
treatment options to an elderly patient just because they are too old
is an example of bias because of age. Stating that an obese patient
is not taking care of himself/herself and does not deserve a certain
treatment option can be another form of discrimination that needs
to be avoided.
Here are some tips that all physicians/providers can do to improve
communication. Make eye contact with all patients when talking to
them; be engaging and personable by sitting down when talking to
patients at length; make sure to converse with a patient in a way
that they can understand; utilize a proper translator when there is
a language barrier in communication. These small gestures will go
a long way in building trust in patients who are culturally different
than the provider.
In short, a conscious effort must be made to address our implicit
and explicit biases which will result in a compassionate and
empathetic physician-patient relationship. n
Reference:
FitzGerald C, Hurst S.
Implicit bias in healthcare professionals: a systematic review.BMC Med Ethics. 2017
Mar 1;18(1):19. doi: 10.1186/s12910-017-0179-8. Review
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