IMPACTS OF IMPLICIT BIAS ON HEALTHCARE

Implicit bias can be a cause of disparities in healthcare assessment and decision-making. For healthcare professionals, an inability to acknowledge the seriousness of implicit bias may also lead to ineffective diagnosis and treatment and poor patient outcomes (Daumeyer et al., 2019).

Research also shows that implicit biases based on race, gender, gender orientation, sexual orientation, weight, and health insurance coverage can influence how healthcare professionals interact with patients in the following ways:

• Quality of assessment
• Diagnostic decision-making process
• Management of symptoms
• Treatment recommendations
• Referrals to specialists
• Interpersonal behaviors such as communication, empathy, trust, etc.
  (Rose, 2022)

A review of a number of research studies shows that bias in the healthcare community has far-reaching consequences for healthcare recipients.

• A literature review from 2018 showed that some medical professionals were more likely to view women experiencing chronic pain as emotional, hysterical, or sensitive.
• Results from a 2019 study showed that more than 80% of medical students had an implicit bias against lesbian and gay people.
• A 2017 study found that healthcare professionals were more likely to assume that older adult patients are offensive, helpless, demanding, and unwilling to receive treatment.
• A 2020 study showed that 83.6% of respondents implicitly preferred people without disabilities and viewed people with disabilities as having a lower quality of life due to their disabilities.
• Results from a 2015 study indicated that healthcare professionals can view people with obesity as lazy, weak-willed, lacking self-control, and unlikely to adhere to treatment regimens.
• Research from 2017 indicated that some physicians may be more likely to think that people from low socioeconomic backgrounds are less intelligent, independent, responsible, and rational than people from higher socioeconomic backgrounds.
  (Smith Haghighi, 2019)

Therefore, healthcare professionals are encouraged to become aware of their own implicit biases, recognize such biases in others, and implement strategies to remedy the negative impacts of implicit bias. The American College of Physicians’ (ACP) position paper clearly advocates not only for universal access to high-quality healthcare in the United States but for ending discrimination based on personal characteristics and understanding and improving social determinants of health (Butkus et al., 2020).

Bias and Health Outcomes Related to Sexual Orientation

Casey and colleagues (2019) examined “reported experiences of discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults in the United States, which broadly contribute to poor health outcomes.” Principle findings include:

• More than 1 in 6 LGBTQ adults reported avoiding healthcare due to anticipated discrimination.
• 16% of LGBTQ adults reported discrimination in healthcare encounters.
• LGBTQ adults experienced interpersonal discrimination, including slurs, microaggressions, sexual harassment, violence, and harassment regarding bathroom use.

A review of 14 qualitative studies regarding the LGBTQ community’s experiences of mental health services showed that members of this community often faced stigma and overt and implicit bias within mental health services. The review found that participants’ experiences of accessing mental health care were related to “experiencing stigma and staff’s lack of knowledge and understanding of LGBT people’s needs” (Rees et al., 2021).

Bias and Health Outcomes Related to Race

The majority of healthcare professionals are dedicated to providing equal and appropriate care to all patients regardless of race. However, healthcare professionals are not immune to implicit racial bias. The 2019 National Healthcare and Disparities Report found disparate impacts on healthcare quality due to race/ethnicity, with White patients more likely to receive better quality care than:

• Black patients
• Native American patients
• Alaska Native patients
• Hispanic patients
• Native Hawaiian/Pacific Islander patients

Research findings indicate that these groups have a harder time accessing healthcare compared to Whites, which can result in treatment delays that lead to poor healthcare outcomes.

In interviews with African Americans receiving mental health services from the U.S. Department of Veterans Affairs (VA) for the purpose of examining their views and experiences of race in healthcare, participants described “threatening cues,” including lack of diverse racial representation in healthcare environments, perceptions of healthcare providers’ fears of Black patients, and fear of being judged negatively based on stereotypes of African Americans. These evaluations of perceived racial bias were found to influence participants’ behaviors and communication during engagement with healthcare professionals (Eliacin et al., 2020).

Similarly, in a meta-analysis of peer-reviewed articles on implicit bias displayed by healthcare professionals, findings indicated that Black patients felt that healthcare providers assumed Black patients to be less adherent than White patients and reported poor provider communication and undertreatment of pain to be significant issues (Fitgerald & Hurst, 2017).

Biased Language and Patient Care

Language used to describe patients may also reflect implicit bias. In one study, stigmatizing language triggered biased behavior in participants. Medical students and residents in internal and emergency medicine programs at an urban academic medical center were presented with a randomized vignette study of two charts using stigmatizing versus neutral language to describe the same hypothetical patient. Exposure to the stigmatizing language in the chart was linked to more negative attitudes toward the patient as well as less aggressive management of the patient’s pain even though the participants were not consciously aware of bias (Goddu et al., 2018).