Studies show that implicit bias leads to discrimination in the health-care, education, and legal systems. It’s been linked to gender and racial health-care disparities and may impede women and underrepresented minorities from entering the medical profession.
But what is implicit bias? And how can the medical profession prevent it from negatively impacting patients, students, and clinicians?
During Sunday’s keynote address, Quinn Capers, IV, MD, an advocate for diversity enhancement in medicine and strategies to reduce health-care disparities, sought to answer those questions for CHEST 2019 attendees.
Dr. Capers, vice dean of faculty affairs at The Ohio State University College of Medicine, began with a look at what implicit bias is—and what it is not.
“Good people can discriminate against other people,” he said. “It is possible, that, at times, you have discriminated others. It’s so important to treat people fairly, but in our field, the medical field, it is critically important.”
It is possible for good people to inadvertently discriminate because the unconscious brain is always working, Dr. Capers said. Even when we’re not actively paying attention or giving the messages we see or hear much thought, our brains are making associations, and those associations can affect how we judge others.
“Implicit race bias is not the same as racism,” he said. “They’re quite different. The difference has to do with intention, awareness, and control.”
When one is aware that they attribute negative characteristics to someone based on race, gender, or sexual orientation, that’s explicit bias.
To understand how implicit bias works, Dr. Capers began with an example using a popular coffee shop logo. While that logo was not a cup of coffee, a quick poll of the audience showed most everyone in the room associated that logo with coffee. That’s a harmless association that can assist people in finding a cup of coffee. However, associations can be harmful, he said.
Dr. Capers shared various examples from news, advertising, and other media of situations that negatively associate young black men with crime or associate white men with professionalism and women with homemaking.
“When you look at an image, it might bring you comfort, or it might make you nervous,” he said. “That’s your unconscious mind trying to do you a favor and help you make sense of the world that we live in.”
Dr. Capers then shared data from numerous studies looking at implicit bias in health care. It’s been demonstrated that physicians are just as likely to have implicit bias as the rest of the population, with one study showing 70% of the U.S. population (and 70% of physicians) have unconscious white race preference.
He described one study where actors—white and black, male and female—were used to describe symptoms of a heart attack. Despite having the same script and emphasizing the same symptoms, the white males were most likely to be referred to a cath lab for testing while black females were least likely to be referred.
Dr. Capers also reviewed data from a study of implicit bias in admissions at The Ohio State University College of Medicine. Not only did the university discover implicit bias was an issue, following the study, they implemented strategies to reduce the effects of bias, and the following year they had the most diverse incoming class in the college’s history.
“We can consciously override these biases,” he said. “That next year, when we had our most diverse class ever, it wasn’t that we admitted more diverse students. It was that more of the diverse students we admitted decided to matriculate, indicating that there was something about the admissions committee that had been trained in implicit bias reduction techniques. They interacted in ways that left minorities feeling that it was an inclusive place, and they’d like to be there.”
Dr. Capers left attendees with a list of the strategies they use at Ohio State to reduce or neutralize implicit bias:
Common Identity Formation: Ask questions about interests and activities that you share in common.
Perspective Taking: Take the perspective of a member of the group against which you have an unconscious bias.
Consider the Opposite: When data seem to point to one conclusion, briefly look for data supporting the opposite conclusion before making a decision.
Counter-Stereotypical Exemplars: Spend time with or focus on individuals you admire from groups against which you have a bias.