Self-awareness helps manage implicit bias in health care

Tracey Straker, M.D., M.S., M.P.H., discusses implicit bias.

All Italian moms are wonderful cooks; girls aren’t good at math; older people aren’t proficient with technology. Those are just a few of the examples of how implicit bias exists in society and affects how we perceive and treat others. Implicit bias is an unconscious assumption about someone based on race, ethnicity, gender, weight, ability, age or sexual orientation.

Implicit bias can be positive. It helps us make quick judgments that allow us to survive. If a bus is barreling toward you, for example, the implicit bias that it is not a good thing helps you get out of the way. But Saturday’s session on implicit bias, “Managing the Impact of Implicit Bias in Health Care,” also brought to light how implicit bias can affect behavior in a patient care setting and contribute to health care disparities in general.

“Implicit bias can impede our ability to work together to deliver the best possible care,” said Tracey Straker, M.D., M.S., M.P.H., Professor of Anesthesiology and attending anesthesiologist at Montefiore Medical Center in Bronx, New York. She led the discussion on the impact of implicit bias in health care.

Overall, implicit bias-related discrepancies have been found regarding cancer treatment, receipt of children’s medications, HIV treatment, diabetes management, treatment of cardiovascular disease, pain management, rates of referral for clinical tests, physician communication behaviors, placement on kidney transplant wait lists, physician perception of patients and amputation.

“Because most of our patients are unconscious, we think there’s no implicit bias in anesthesiology,” said Alexandra Bastien, M.D., Assistant Professor of Anesthesiology, also with Montefiore Medical Center.

Evidence suggests that implicit bias can impact the decision-making process of health care providers in all disciplines. That can lead to health disparities, affect patient-provider relations, treatment decisions, treatment adherence and patient health outcomes.

“High levels of bias lead to less friendly behavior toward patients and less patient satisfaction,” said Elise Delphin, M.D., M.P.H., Chair of Anesthesiology at Albert Einstein College of Medicine and Montefiore Medical Center.

The good news? Implicit bias isn’t permanent or ingrained.

“Changing it starts with providers understanding that implicit bias exists,” said Dr. Delphin. Awareness is key to changing thoughts and behavior. For starters, discover what your implicit biases are by taking the online assessment at The assessment was developed in 1998 by researchers from Harvard University, the University of Washington and the University of Virginia.

“You can’t get rid of it by suppressing the bias or having good intentions. It has to come from within,” said Dr. Delphin. To learn how to respond without bias, try taking these steps:

  • Use evidence-based treatment protocols so all patients who walk in with chest pain, for example, are treated the same way.
  • Change hiring practices. To decrease bias toward patients means having a more diverse group of providers, too. Set up scripted interviews that can help when interviewing applicants.
  • Try to be aware of your emotional state when interviewing a patient. Providers who are in a positive emotional state, and not stressed, are apt to be more empathetic and less biased toward patients.

“We need to improve our ability to build partnerships with patients by building a mindset that allows us to grow,” said Dr. Delphin. She recommended two nonfiction books to increase your awareness about implicit bias: Whistling Vivaldi by Claude M. Steele, and Blind Spot: Hidden Biases of Good People by Mahzarin R. Banaji and Anthony G. Greenwald.

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