Implicit Bias and Its Effect on Patient Care

Jordan M. Miller, 4^th Year Pharmacy Student
University of Tennessee College of Pharmacy

Carli C. Smith, PharmD
VA-Tennessee Valley Healthcare System

Jennifer Bean, Pharm.D., BCPS, BCPP
Associate Service Chief of Pharmacy, Clinical & Educational Programs
PGY1 Pharmacy Residency Program Director
PGY2 Psychiatric Pharmacy Residency Program Director
VA-Tennessee Valley Healthcare System

What is Implicit Bias?

Recognizing patterns in the environment around us is part of human nature. Then without realizing it, these patterns can develop into stereotypes. Most people will not admit that they might have biased opinions or stereotypical viewpoints, but unconsciously these thoughts sometimes influence the actions and decisions that are made. This idea of unconscious, uncontrollable, or irrational thought processes that can affect our judgments and daily interactions is known as implicit bias.¹ Implicit bias encompasses characteristics of race, gender, sexual orientation, physical appearance, age, financial status, disability, mental illness, and many other areas. Some people associate these characteristics with negative evaluations that can affect the verbal and non-verbal communication, actions, or decisions taken. In the health care industry, clinicians and staff having implicit biases towards certain groups can negatively affect the care that these groups receive.

How Does Implicit Bias Affect the Quality of Patient Care?

Health care workers provide services to a diverse population of patients, so understanding implicit biases is especially important in providing individualized, quality care. Unconscious thought processes and decision-making can affect the provider-patient interaction, therapeutic options, diagnoses, and other areas of health care. A 2017 systematic review revealed that health care professionals exhibit about the same levels of implicit bias as the general population does, and evidence indicates that biases are likely to influence diagnosis and treatment decisions in some circumstances.¹ Even professional clinicians with a lot of experience interacting with diverse groups have implicit biases. A 2015 study by Kopera and colleagues showed that mental health professionals had better approach emotions, expressing more compassion, sadness, interest, and acceptance than non-professional, medical students towards mentally ill patients, but both groups held negative implicit bias attitudes towards the mentally ill.²

Most clinicians would agree that everyone should receive the same level of care despite their race, gender, orientation, or physical and mental status. In order to ensure equality of care, it is important to understand cultural competency and establish a framework for preventing implicit bias.

Understanding and Overcoming Implicit Bias

A 2018 survey found that only 17% of CPNP members felt that they were competent in the area of implicit bias. From these results, we can conclude that there is a need for proper tools and guidance to improve awareness and reduce unintentional bias among health care workers. In a 2007 article, Dr. Diana Burgess and colleagues lay out a social and cognitive-based framework aimed to prevent unconscious stereotypes from impacting clinical decisions.³ To reduce bias, the authors propose that is important to treat patients as individuals as opposed to categorically defining them by their group membership. The four pillars of the framework to achieve this, include:

1. Motivation: Increasing awareness of implicit biases and understanding your own self can help to improve internal motivation. One way to do this is to take an Implicit Association Test (IAT), such as the one Harvard University provides. An example is the Harvard - Project Implicit, Mental Health IAT. This test can help to identify your unconscious or uncontrolled reactions to mental health disorders or people with mental illnesses.⁴
2. Information: Stereotypes are a natural phenomenon in today’s society. Informing people on the psychological basis of bias, and then letting them confront the bias through direct interaction with socially dissimilar patients will help to improve overall communication skills and overcoming the stereotypes.
3. Emotion: Research has shown that people who experience higher levels of positive emotions during clinical interactions are less likely to categorize patients. Performing stress-reducing techniques, such as meditation, before patient encounters can enhance emotional well-being to reduce provider bias.
4. Orientation: Partnership building into provider-patient interactions helps both individuals to develop “common ground” and become a team during clinical encounters. This creation of a partnership helps to reduce bias and improve patient-centered care.

Implicit Bias Keynote Presentation at CPNP 2019

Dr. Quinn Capers, MD, FACC, FSCAI, Associate Dean of Admissions at The Ohio State University School of Medicine, will present “Overcoming Implicit Bias in Health Care,” the Monday opening keynote presentation for CPNP 2019 on April 8, 2019 in Salt Lake City. After this presentation, participants will be able to:

1. Define implicit and explicit bias in health care and how it can impact the provision of patient care.
2. Describe the prevalence and factors associated with negative implicit attitudes of health care providers towards patients living with mental illness
3. Identify strategies to recognize one’s own implicit biases and minimize the impact implicit bias has in providing patient care.

Overall, implicit bias is present among the general population and amongst health care workers. It is important for clinicians to understand and improve upon their implicit biases to provide quality patient-centered care. Join your peers at CPNP 2019 to learn more about this important topic.

References

1. FitzGerald, Chloë, and Samia Hurst. “Implicit Bias in Healthcare Professionals: A Systematic Review.” BMC Medical Ethics 18 (2017): 19. PMC. Web. 19 Oct. 2018.
2. Kopera, Maciej et al. “Evaluating Explicit and Implicit Stigma of Mental Illness in Mental Health Professionals and Medical Students.” Community Mental Health Journal 51.5 (2015): 628–634. PMC. Web. 19 Oct. 2018.
3. Burgess, Diana et al. “Reducing Racial Bias Among Health Care Providers: Lessons from Social-Cognitive Psychology.” Journal of General Internal Medicine 22.6 (2007): 882–887. PMC. Web. 19 Oct. 2018.
4. Mental Health Project Implicit. 2018. https://implicit.harvard.edu/implicit/user/pimh/index.jsp