Special Report: Implicit Bias

EM:RAP Special Report: Implicit Bias

Jessica Mason, MD and Medell Briggs, MD

Biases can be positive or negative, explicit, or implicit. Implicit biases in medicine can be dangerous because they can change our relationship with our patients and affect treatment. Underlying biases may be amplified during times of stress. Many groups are targets of implicit bias, with some of the common ones including people of color (including black and Hispanic), women, Muslim, LGBTQ, and obese patients. Many studies have demonstrated the negative effects of bias in medicine (see references). 

We should also take notice of the words we use to describe patients. Commonly used terms like “Hispanic panic” are inappropriate and unacceptable. Labeling patients with terms that are derogatory or dismissive are disrespectful and can change the behavior of the healthcare team leading to negative outcomes such as undertreating pain or missing life threatening diagnoses.

Dr. Briggs is a leader in quality improvement at UCLA and has worked to identify trends in negative outcomes with specific attention towards the possibility of bias influencing healthcare. As trends are identified she is able to create educational interventions for quality improvement. 

Healthcare providers are also sometimes the target of bias by patients, which should not be tolerated. When this happens set boundaries, support each other, and in some instances consider transitioning care to another clinician. 

Research demonstrates that healthcare professionals have the same levels of implicit bias as the population as a whole. It is important that we learn to recognize biases, remove them from educational curricula, and make bias training part of a longitudinal curriculum.

References

Tajeu GS, Halanych J, Juarez L, Stone J, Stepanikova I, Green A, Cherrington AL. Exploring the association of healthcare worker race and occupation with implicit and explicit racial bias. Journal of the National Medical Association. 2018 Oct 1;110(5):464-72. https://doi.org/10.1016/j.jnma.2017.12.001

Maina IW, Belton TD, Ginzberg S, Singh A, Johnson TJ. A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Social Science & Medicine. 2018 Feb 1;199:219-29. https://doi.org/10.1016/j.socscimed.2017.05.009

Dehon E, Weiss N, Jones J, Faulconer W, Hinton E, Sterling S. A systematic review of the impact of physician implicit racial bias on clinical decision making. Academic Emergency Medicine. 2017 Aug;24(8):895-904. https://doi.org/10.1111/acem.13214

FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC medical ethics. 2017 Dec;18(1):19. https://doi.org/10.1186/s12910-017-0179-8

Johnson TJ, Hickey RW, Switzer GE, Miller E, Winger DG, Nguyen M, Saladino RA, Hausmann LR. The impact of cognitive stressors in the emergency department on physician implicit racial bias. Academic emergency medicine. 2016 Mar;23(3):297-305. https://doi.org/10.1111/acem.12901

Mackey C, Diercks DB. Gender bias in the management of patients still exists. Academic Emergency Medicine. 2018 Apr;25(4):467-9. https://doi.org/10.1111/acem.13394