Researchers are also examining ways that providers may inadvertently demonstrate such bias, including through language. The team found that black patients felt most negatively toward physicians who were low in explicit bias but high in implicit bias, demonstrating the validity of the implicit-bias theory in real-world medical interactions, says Penner ( Journal of Experimental Social Psychology, Vol. The researchers also video-recorded patients and physicians during the appointment and asked them to complete questionnaires afterward. Along with Dovidio, Gaertner and others, he asked patients and physicians before a medical appointment about their race-related attitudes, and measured physicians’ implicit bias. Penner, PhD, senior scientist at Wayne State University’s Karmanos Cancer Institute. One of the first psychologists to apply theories of aversive racism and implicit bias in a real-world medical setting is social psychologist Louis A. “This kind of research is essential in making real progress toward health-care equality.” How bias plays out “Implicit bias creates inequalities through many difficult-to-measure pathways, and as a consequence,people tend to underestimate its impact,” says van Ryn. But it is worth a deeper dive because of its implications for patient treatment on both a personal and a health-care level, she says. Implicit bias is called implicit for a reason-it’s not easy to capture or to fix, says Michelle van Ryn, PhD, an endowed professor at Oregon Health & Science University (OHSU). And while the predictive power of the IAT may be relatively small, in the aggregate, even small effects can have large consequences for minority patients (see Journal of Personality and Social Psychology, Vol. While this disagreement remains to be resolved, researchers are starting to use other measures and techniques to assess implicit bias, as well as new methodologies to track patient attitudes and outcomes. Another problem is that the main measure used to assess implicit bias, the Implicit Association Test (IAT), has come under fire in recent years for reasons including poor test-retest reliability and the argument that higher IAT scores do not necessarily predict biased behavior. Tackling this topic can be difficult because of the real-world challenges of getting medical professionals to engage in these studies, researchers say. Research is also starting to look at how implicit bias affects the dynamics of physician-patient relationships and subsequent care for patients with particular diseases, such as cancer and diabetes. Psychologists and others are now building on the IoM findings by exploring how specific factors, including physicians’ use of patronizing language and patients’ past experiences with discrimination, affect patients’ perception of providers and care. “The report really opened a lot of doors to further research on bias in care,” says Dovidio, who served on the IoM panel. The report concluded that even when access-to-care barriers such as insurance and family income were controlled for, racial and ethnic minorities received worse health care than nonminorities, and that both explicit and implicit bias played potential roles. In 2003, the concepts received an empirical boost from “Unequal Treatment,” a report from an Institute of Medicine (IoM) panel made up of behavioral scientists, physicians, public health experts and other health professionals. Lab studies have long tested these ideas in relation to employment decisions, legal decisions and more. When there’s a conflict between a person’s explicit and implicit attitudes-when people say they’re not prejudiced but give subtle signals that they are, for example-those on the receiving end may be left anxious and confused. Dovidio, PhD, of Yale University, people may hold negative nonconscious or automatic feelings and beliefs about others that can differ from their conscious attitudes, a phenomenon known as implicit bias. Gaertner, PhD, of the University of Delaware, and John F. Describe possible interventions to improve patient-physician interactions.įor more information on earning CE credit for this article, go to The theory of aversive racism, first posed in the 1970s, encompasses some of the most widely studied ideas in social psychology.Discuss how certain combinations of physicians and patients lead to poorer interactions.
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