Talking About Implicit Bias In Medicine

Lately in the field of medicine, discussing socio-medical topics like implicit bias has become more common. “Also known as implicit social cognition, implicit bias refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.  These biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control.”¹ An example of an implicit bias is someone assuming a woman wearing scrubs at a hospital is a nurse, rather an a physician. Everyone has implicit biases. Because implicit biases are so pervasive, it is important to be aware that they exist. When physicians use implicit biases to make decisions in medicine, it may lead to misunderstanding, misdiagnosis, or worse. Implicit bias is subconscious, so it can be hard to detect, but it is important to have these conversations in order to improve patient care and satisfaction.

I once spoke to a teenage girl living in an urban location who had severe abdominal pains. Because she was a black teenager in an urban city, the doctors at the hospital assumed that she was either pregnant or had an STD. As a result, she had a number of gynecological exams over the course of  three months. Meanwhile, her condition continued to worsen. After her mother asked to have her daughter seen by a gastroenterologist she was correctly diagnosed with Crohn’s Disease. Because of numerous doctors’ implicit biases about black female teenagers in urban cities, this patient spent three months suffering, when she may have been diagnosed and relieved of her pain much earlier. The stereotypes these doctors held impeded her treatment.

I have had a couple of family members who passed away from medical illnesses that were unfortunately misdiagnosed in early stages. It was upsetting for me and my family, and we were left wondering, “What if the illness was diagnosed correctly?” Sometimes I wonder if implicit biases played a role. Ultimately, this thought was one of the reasons why I want to become a physician. In addition to my love of medicine and serving people, I feel that diversity in the healthcare workforce is so crucial, in order to possibly help reduce the occurrence of implicit bias that may result in misdiagnosis in some patients.

It’s important to recognize that patients have their own implicit biases as well. In many communities, patients approach physicians with a suspicion and mistrust. This mindset may come from repeated incidents in history where patients were mistreated by their physicians for research.² However, this mistrust may lead to patients being reluctant to seek or comply with suggested treatment.

It is important that physicians come from different races and backgrounds so that the impact of implicit biases can be reduced. It is also imperative that physicians and other healthcare providers openly talk about implicit bias and discuss how it may affect them and their patients. In order to reduce the effects of implicit bias, knowledge of implicit bias needs to be built into the educational and training process for future physicians and healthcare workers. With honest and open discussion, physicians can understand and identify certain biases they may have, and methods and strategies can be created to mitigate the impact of implicit bias on patient diagnosis or care.

1. Understanding Implicit Bias. Retrieved from http://kirwaninstitute.osu.edu/research/understanding-implicit-bias

2. Brandon, D.T., (2005, July 7). The legacy of Tuskegee and trust in medical care: is Tuskegee responsible for race differences in mistrust of medical care?. Retrieved from https://www-ncbi-nlm-nih-gov.ezp.welch.jhmi.edu/pubmed/16080664