Implicit Bias

Implicit bias and health care delivery

- patients shouldn't receive inferior care b/c of race, age or other characteristic(s) - implicit associations can influence our judgements resulting in bias - in addition to affecting judgements, implicit biases manifest in our non-verbal behaviors towards others - implicit biases explain potential dissociations between what a person explicitly believes and wants to do ( treat everyone equally) and the hidden influence of negative implicit associations on his/her thoughts and action (e.g. perceiving a patient of specific race, gender or SES status as less competent and thus deciding not to prescribe a medication or therapy)

Aversion bias as racial bias

- rather than open hostility as in explicit bias, aversion bias often involves discomfort uneasiness, disgust, or fear - may be manifest as nonverbal behaviors: reduced eye contact, increased blinking, avoidance, or closed postures

Strategies to combat implicit bias

- stereotype replacement — Recognizing that a response is based on stereotype and consciously adjusting the response - counter-stereotypic imaging — Imagining the individual as the opposite of the stereotype - individuation — Seeing the person as an individual rather than a stereotype (e.g., learning about their personal history and the context that brought them to the office or health center) - perspective taking — "Putting yourself in the other person's shoes" - increasing contact with individuals from different groups — Expanding your network of friends and colleagues or attend events where people of other racial/ethnic groups, gender identities, sexual orientation, and other groups may be present - partnership building — Reframing the interaction with the patient as one between collaborating equals

Eliminating unconscious racial/ ethnic bias as a cause of health disparities

- an important step in breaking down bias is the development of cultural competence-providing care to patients with diverse values, beliefs and behaviors, including the tailoring of healthcare delivery to meet patients' social, cultural and linguistic needs - being a culturally competent health system requires behaviors, attitudes, and policies that support effective interactions in cross-cultural situations - in addition to wanting to deliver the best possible health care, we, as PAs have the ARC-PA Accreditation Standard B1.06 (a "must" standard) to guide our curriculum. This standard states that "the curriculum must include instruction to prepare students to provide medical care to patients from diverse populations

Communication patterns and perception of care

- clinicians' implicit general race bias and race and compliance stereotyping were measured with 2 implicit association tests and related to audiotape measures of visit communication and patient ratings - more implicit bias on the race attitude IAT was linked to 2 measures of communication process: more clinician verbal dominance in the visits of Blacks and lower patient positive affect score in the visits of Blacks - for Black patients, higher levels of implicit bias on the race attitude IAT were also linked to lower perceived respect from the clinician, liking the clinician themselves, having confidence in the clinician, and recommending the clinician to others

Healthcare providers and implicit bias

- evidence indicates that healthcare professional exhibit the same levels of implicit bias as the wider population - studies combing implicit bias testing and the quality of care indicate that implicit biases likely influence diagnosis, treatment decision making and perceived levels of care

Implicit biases

- implicit biases are pervasive - most of us possess them - the implicit associations we hold do not necessarily align with our declared beliefs or even reflect stances we would endorse - we generally hold implicit biases that favor our in-group, but we may hold implicit biases against our in-group - implicit biases are malleable

Motivation to break the prejudice habit stems from two sources

- people must be aware of their biases - they must be concerned about the consequences of their biases before they will be motivated to exert effort to eliminate them

Poor satisfaction with care in racial minorities

- the quality of patient-physician interactions is lower among non-White patients, particularly Latinos and Asian Americans - lower quality patient-physician interactions are associated with lower overall satisfaction with health care - asian Americans are least likely to feel that their doctor understood their background and values and are most likely to report that their doctor looked down on them

Implicit bias or thoughts about people you didn't know you had

- these biases, 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 choose to conceal for the purposes of social and/ or political correctness - implicit biases are not accessible through introspection

Implicit biases are malleable

implicit associations that we have formed can be gradually unlearned through de- biasing techniques

Factors shown to be impactful for healthcare providers and implicit bias

race/ethnicity, gender, socio-economic status (SES), age, mental illness, weight, HIV/ AIDS, brain injured patients, persons who use intravenous drugs, disabilities, and social circumstances

Implicit bias definition

the attitudes or stereotypes that affect out understanding, actions, and decisions in an unconscious manner