Implicit Bias in Healthcare
Doctors have the duty to treat patients equally, regardless of their gender, age, race, or medical history. However, research shows that despite best efforts at accomplishing this healthcare providers can unknowingly fall short. The California Legislative Counsel defines implicit bias as meaning the attitudes or internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner, and often contributes to unequal treatment of people based on race, ethnicity, gender identity, sexual orientation, age, disability, and other characteristics. The stark difference that implicit bias has from explicit bias is that you are unaware of the positive or negative attitudes you hold towards a group of people.
Healthcare is not immune to the effects of implicit biases. Racial disparities in health and healthcare earned the No. 1 spot on ECRI’s list of the top 10 patient safety concerns for 2021. Numerous studies highlight how implicit bias creates and perpetuates healthcare disparities, ultimately leading to some patients receiving a lower standard of care. According to the CDC, Pregnancy-related deaths per 100,000 live births (the pregnancy-related mortality ratio or PRMR) for black, American Indian, and Alaska Native women older than 30 was four to five times as high as it was for white women. Additionally, black women are 22 percent more likely to die from heart disease, 71 percent more likely to die from cervical cancer (Nina Martin, ProPublica). The Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services, found that relative to non-Hispanic whites, racial and ethnic minorities are less likely to receive appropriate cancer care, cardiac care, diabetes care, pediatric care and many surgical procedures. Another study published in 2019 by Circulation: Heart Failure found people of black or Latin American descent coming to the ED with cardiac symptoms were less likely to be admitted to specialized cardiology units than white patients. How does this impact malpractice? If a plaintiff alleged, they received poor care because of their race, gender, or sexual orientation would there be admissible evidence to support this in your setting? Plaintiff attorneys can attempt to establish discrimination as the root cause of medical malpractice by digging into patterns established through time spent with patients, patient mix, and consistency of treatment recommendations based on race, sex, or ethnicity.
The healthcare industry is responding to these alarming statistics. Hospitals and healthcare providers are taking steps to recognize their own implicit biases and implementing training and policy changes to help mitigate the problem. The American College of Cardiology published an article in Jan. 2020 that stressed the importance of evidence-based medicine in the clinical setting and using checklists and standardized order sets to help make sure minority patients are not undertreated. Others are employing patient navigators to assist marginalized patients with navigating a complex healthcare system.
While it may not be possible to eliminate unconscious biases completely, taking steps to understand and learn how they manifest in practice can help move us in the right direction. Members of MIEC have access to Implicit Bias training through Med-IQ. Our Racism and Implicit Bias: Legacies and Applied Concepts course offers 1.5 hrs of CME. You can access the course here.