News and Commentary Managing Implicit Bias for Better Health Outcomes

Cristina M. Gonzalez, MD, MEd, of Albert Einstein College of Medicine, discusses how implicit bias sometimes plays into medical decision-making and how health professions education can manage its impact.

Implicit biases are the unconscious assumptions we make about others. These biases, also often referred to as unconscious stereotypes, may vary among individuals, and are a product of our life experience.

While the term “implicit bias” evokes a negative connotation, there are times when unconscious thinking is good. After all, we need unconscious thinking in order to go about our daily lives. Imagine if everything you did, like hold a pen or open a door, is something you had to consciously think about. You’d get a lot less done, that’s for sure.

In the health care setting, however, implicit biases can sometimes have a negative impact. As providers, jumping to conclusions about our patients based on unconscious assumptions can lead to less than optimal care. Although the medical profession strives for equal treatment of all patients, countless studies have found that disparities in health care are prevalent, particularly in the types and quality of health services received for people from different backgrounds including race, gender, religious affiliation or sexual orientation. One factor contributing to these inequities in care, research suggests, is implicit bias. A study out of Harvard, for example, found that the care black patients received for chest pain differed from the care that white patients received who exhibited the exact same behavior and symptoms.

Often, providers are not consciously aware of the implicit bias at play and how those biases affect the care we deliver. We go into the field with good intentions and are good people working hard to provide the best care we can. As providers, it is our responsibility to recognize and manage this implicit bias. Ultimately, this will enable us to make more equitable decisions and result in better patient safety and health outcomes for all our patients.

The Role of Health Professions Education
With mounting evidence that implicit biases sometimes negatively impact patient care, we need to ensure the next generation of providers understand how to identify and reconcile unconscious attitudes and stereotypes toward patients and their families—and even one another.

Biases often come up for providers when they are stressed, tired, or unsure of a diagnosis. Helping students understand these trigger points early on before clinical decision-making behaviors are fully formed will help them become more empathetic and effective doctors.

There are two potential paths forward to make this happen:

  • Culture Change: We need to move away from the “shame and blame” approach and remove the stigma of implicit bias. To start, we need to normalize implicit bias and bring everyone—both students and faculty—to a point where they can talk openly about implicit bias, without judgement.
  • new-curriculum-content: Instead of being a one-off elective, content addressing implicit bias in clinical decision-making needs to be woven throughout health professions curricula at all degree levels. new-curriculum-content on implicit bias should be embedded in content areas like quality improvement and patient safety, and clinical reasoning skills. This also needs to be taught over time and in different settings and ways—both lecture and hands on learning (e.g. role-playing). You would never expect someone to learn biochemistry in one session. Learning to manage our unconscious assumptions is no different.

A Promising Pilot
As a Macy Faculty Scholar I am currently developing and implementing a longitudinal curriculum for Einstein medical students in implicit bias recognition and management. The goal of my project is to decrease provider contributions to healthcare disparities by mitigating the influence of implicit bias on clinical decision-making, eventually improving patient outcomes.

Through active learning exercises and role-play, my students are immersing themselves in situations that we as providers find ourselves in every day—those hard conversations and encounters we often look back on and wish we handled differently. This fall, I’ll be expanding the curriculum and making improvements based on last year’s student feedback.

At the end of the day, I believe that as providers we all have good intentions. With my Macy project I want to capitalize on these good intentions and make more health professionals aware of what influences their decision-making. I want to help students recognize when biases may creep up in caring for patients and help them manage it before communication patterns and health care decisions are impacted.

Everyone is on their own journey. We as people—not just providers—need to be more empathetic of one-another and recognize our differences. This will help advance our health care system for everyone and enhance our ability to provide exceptional, equitable care to all of our patients.

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