What Is Implicit Bias?
Most people know the word "bias" and do not struggle to understand what it means. However, the words "implicit bias" can be a lot harder for some folks to wrap their minds around, usually because people do not want to think of themselves as biased. We all have implicit biases. Implicit biases are our unconscious and automatic beliefs about others that influence our behaviors. Implicit biases are outside of awareness and at times can really conflict with our perception of ourselves. For example, people can view themselves as not racist, but can act in ways that demonstrate bias against certain groups of people.
Implicit biases can affect hiring practices, personal interactions, educational opportunities, encounters with the criminal justice system, and medical care. Let's explore implicit bias in health care.
Effects of Implicit Bias in Health Care!
The Institute of Medicine issued a report in 2003 that concluded that even when access to care barriers, such as insurance, family income, and other factors were controlled for, racial and ethnic minorities received worse health care than non-minorities. There is an unfortunate amount of explicit bias that plays into these results, however, there is a component of implicit bias as well. For example, in a study of black cancer patients, physicians who scored higher on measures of implicit bias were less supportive and spent less time with their patients than doctors who scored low on implicit bias (Penner, Dovidio, et al., 2016). Further, similar effects were found when looking at medical students' levels of implicit biases towards patients who are obese or who identify as LGBT (Phelan, 2017). There has also been ample recent research indicating that women of color are more likely to die from childbirth complications that white women, with the risk of death 3-4 times higher for black women, even when income and education are controlled for. Implicit bias has been implicated in significantly contributing to these numbers, as black women's expressions of pain or discomfort tend to not be heard or taken as seriously as their white female counterparts. All too often in my clinical practice I have heard women, of many races and backgrounds, describe experiences with male doctors who were dismissive of their pain and who were too quickly told that it is just "stress" and that they need to "relax", only to later discover a very real and concrete medical diagnosis.
Implicit bias is everywhere, including in the institution of medicine, so what can be done about it? Thankfully medical schools are becoming more and more aware of this reality and are conducting studies to explore and implement how to combat it. But what can be done on the individual level to spot potential bias and to increase your chances of receiving adequate health care?
1. Be on the look out for dismissive language! Doctors who tend to score higher on measures of implicit bias, tend to use the pronoun "we" rather than "you" when discussing treatment plans with certain groups of patients (Hagiwara, 2017). For example, "We are going to avoid sugar and eat healthy, aren't we?" Think about how this phrase sounds. Sounds like a parent talking to a child, rather than an adult speaking to another adult. This can be demonstrative of unequal power dynamics that go beyond the normative doctor-patient relationship.
2. Ask Yourself, "Are You Being Heard?" Research has found that doctors who scored higher on implicit bias tended to speak much more during patient-doctor talk-time (e.g. Hagiwara, 2013 & Cooper, 2012). It is very important to feel like you are being heard and that there is ample time to ask your questions and have them answered in a manner that communicates that you have been taken seriously.
3. Have You Noticed That Odd Assumptions are Being Made About You Repeatedly? For example, if you are a woman, was it assumed that you are reserved about a certain medication option because you're concerned about weight gain? If you are a person of color, was it assumed that you don't have a college degree? The list of assumptions can be endless but I am sure you have your own examples of such situations. We all have biases and assumptions; however, it is when you start to notice a pattern of multiple stereotypical assumptions being made that it may behoove you to wonder about what is going on.
4. Trust Your Gut! It is important to trust your doctor and to therefore trust your gut feeling. If your gut is telling you that something is not right, then get a second opinion. It is crucial to feel like you can trust that your doctor is listening to you and taking your concerns seriously. A doctor who is really your advocate will be ok with you getting a second opinion.
If you find yourself wondering about how implicit bias impacts your life, both either as someone who engages in implicit bias or is the recipient of it, feel free to reach out for a consultation. If you are interested in Diversity & Inclusion workshops or training, please schedule a phone consultation on GreenTPsychology.com
Hagiwara, N. (2017). Health Communication, 32 (4).
Hagiwara, N. & Cooper, L.A. (2012). American Journal of Public Health, 102 (5).
Penner, A., Dovidio, G., et al. (2016). Clinical Oncology, 34, (24).
Phelan, S. (2017). Journal of General Internal Medicine, 32 (11).