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Overview:

Implicit biases are unconscious biases people have, and in healthcare, it can affect treatment and patient outcome. The blog explains how implicit bias affects healthcare and what can be done to overcome it.

Bias refers to a person’s impression about someone. Bias can be positive or negative and it affects the way the person interacts with the people who he has biases for/against.

There are explicit biases and implicit biases. Explicit biases are notions people have towards certain groups of people by whom they usually feel threatened. They are also conscious of behaving in a biased manner.

Implicit biases on the other hand are unconscious biases people have towards certain groups of people based on factors like gender, socioeconomic status, etc. Here, people believe that they are treating others fairly when in reality their actions are actually influenced by their biases.

Acknowledging the Bias

The healthcare industry always strives to provide equitable care. The earnest efforts of healthcare leaders, doctors, medical and non-medical staff are all aimed towards providing every patient with the best personalized care that will provide the desired outcome for them.

However, it is human tendency to have biases and no one is free from them – including healthcare professionals. Even with the best of intentions, implicit biases can affect treatment. While it might be hard to digest this, acknowledging that the bias exists is the first and most important step in addressing it.

Understanding the Effect of the Bias

Given below are a few examples of how implicit biases may manifest in healthcare settings.

• Gender:
  • Men are often perceived to be brave and stoic while dealing with pain while women dealing with pain are perceived as fussy and oversensitive.
  • These assumptions affect the medical treatment for both men and women negatively – the pain women experience might be dismissively dealt with, while men might try to put up a stand of false bravado and defer treatment.
  • Transgenders too are often subjected to implicit biases ranging from conflicting ideas on gender identity to simply a lack of understanding about transgender needs which could result in an unpleasant patient experience for them.
• Age:
  • Older people might be regarded as challenging and inflexible.
  • Invasive procedures might generally be avoided for them as healthcare professionals may assume they are being compassionate by not suggesting surgeries for them.
  • However, this might not be the best choice for the patients as quality of life could get affected.
• Ableism:
  • Healthcare for differently-abled people could also be unconsciously affected by implicit biases as healthcare providers may believe that a health condition is the result of a disability.
  • This will affect the treatment for the condition the patient presents with.
  • Healthcare settings too could make differently-abled people feel that their needs have been overlooked. For example, a wheelchair bound person might have trouble accessing all the diagnostic facilities in a healthcare centre.
• Weight:
  • A patient who is obese might be perceived as idle and not willing to make an effort to lose weight.
  • Symptoms of a health condition may be attributed to obesity and treatment for the condition could be sidelined.
• Socioeconomic Status:
  • People who are unemployed or who have very low income may be regarded as simpleminded and hence unlikely to turn up for a follow-up.
  • This could affect the treatment rendered to them as aggressive treatment plans requiring commitment might not be suggested to them.
  • Preventive care for them could also be disregarded as it may be believed that they will not want to invest in it.

Implicit Biases Extend Beyond Patient Care

While patients are impacted directly, implicit biases can go further and affect other aspects in a healthcare organization.

• Hiring and promotion practices can be affected which might lead to a lack of diversity among the staff as well as the leadership. Lack of diversity will in turn affect the way decisions are made and new perspectives are received. The organization could end up losing in terms of creativity and innovation.
• Biases can also invade clinical studies by not universally covering all sections of society. Consequently, the results of the study and the changes in treatment modalities recommended will not be pertinent to all.
• On the whole, all these factors together will affect the relationship between patients and healthcare providers, leading to a decline in trust and satisfaction.

Bringing About Change

There is no easy solution to this. As with all issues, education and understanding form the core of the solution.

• Healthcare providers first need to be made aware of the implicit biases they harbor if they are to change them. They should also be educated on how detrimental these biases can be for the patients.
• Efforts should be made to seek out diverse opinions which can help understand situations comprehensively, thus enabling better decision-making and promoting empathy.
• Self-reflection should be promoted to make one aware of one’s beliefs and attitudes.
• Organizational policies should be examined and modified if required to weed out any inadvertent biased practices.
• Having a diverse leadership will enable better policy making and make a push to ensure resources reach all the people who require them irrespective of their circumstances.

Individual Approaches to Combat Implicit Bias

Health equity forms the core of doctors’ beliefs. Once they are made to understand the pervasive nature of implicit biases, all healthcare professionals will want to take steps to eliminate it. The following will help:

• Dropping all pretexts, taking a look at themselves, and honestly evaluating their biases.
• Getting feedback from patients and colleagues and being mentally prepared to accept that feedback.
• Practicing mindfulness to be in tune with thoughts.
• Have an open mind while interacting with people from different cultural backgrounds to remove preconceived notions about them.
• Listening actively to what patients are reporting without letting assumptions cloud judgement.

Implicit bias is unintentional but it can lead to bad patient experiences and healthcare disparities. By acknowledging it, we take up the responsibility to set it right and pave the way for a better healthcare system.

Frequently Asked Questions

What is implicit bias in healthcare?

Implicit bias in healthcare refers to unconscious attitudes or stereotypes that affect the treatment and care decisions made by medical professionals, often without them realizing it.

How does implicit bias affect patient care?

It can lead to misdiagnosis, delayed treatment, or poor communication, especially with patients from diverse genders, age, weight, or socioeconomic backgrounds.

What are some examples of implicit bias in healthcare?

Examples include assuming women exaggerate pain, avoiding surgery for elderly patients, attributing all health issues in obese patients to weight, or underestimating low-income patients' compliance.

Can implicit bias be reduced in healthcare?

Yes, through awareness training, promoting diversity in hiring, encouraging self-reflection among providers, and developing bias-free organizational policies.

Why is understanding implicit bias important in healthcare?

Recognizing and addressing bias helps build trust, improve health outcomes, and ensure fair, respectful, and personalized care for every patient.