Implicit Bias in Healthcare
Original Editor - Tarina van der Stockt
Top Contributors - Tarina van der Stockt, Jess Bell, Ewa Jaraczewska and Stacy Schiurring
Introduction[edit | edit source]
To be able to deliver impartial healthcare we need to be wary of any kind of negative evaluation towards people from a specific group or someone with particular characteristics.[1] Implicit biases are those attitudes and beliefs that we harbour about specific people or groups of people at an unconscious level.[2] Even though these biases are unconscious and we might not be aware of it they still influence our judgements, behaviours and decisions.[3]
Thus implicit bias refers to a potential disconnection between what someone explicitly believes and wants to do and the unseen influence of negative implicit associations on what they think and how they behave.[1]It also relates to stereotyping as implicit biases is one of the reasons people attribute particular characteristics and qualities to all individuals belonging to a specific group.[4]
“Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender.” [1]
Everyone Has Implicit Biases[edit | edit source]
Everyone has implicit biases, this is because our brains have a natural tendency to sift, sort and categorise information which in turn could lead to implicit biases.[4]
The following tendencies make us susceptible to implicit bias:[4][5]
- our brains have a tendency to find patterns and associations in the world.
- our brains are inundated with information and try to simplify the world by taking mental shortcuts to make it easier to sort through all of the data
- experiences (it does not have to be direct experiences) influence our implicit biases.
We can pick up biases from the people who trained us or be biased towards our own race. [6]
Implicit Bias in Healthcare[edit | edit source]
There are well established research on the role of implicit bias in health care in social psychology and on health care processes.[7]
Most studies on this subject is conducted on doctors and nurses.[8]All the studies in a systematic review showed biases among physicians and nurses. The following characteristics were listed as triggers for implicit bias: "race/ethnicity, gender, socio-economic status, age, mental illness, weight, having AIDS, brain injured patients perceived to have contributed to their injury, intravenous drug users, disability, and social circumstances".[1]
Physiotherapists work in a variety of settings, including hospitals, outpatient clinics and patient homes and come across people from different backgrounds and abilities. Physiotherapists have a higher frequency of patient visits compared to other healthcare practitioners and therefore a trusting patient relationship is crucial and successful patient outcomes are linked to the patient’s adherence to the plan of care.[8]A physiotherapist's implicit bias can negatively affect patient care.[8]
In a study of 59 physiotherapy participants the authors found that the sample of orthopaedic and paediatric physiotherapists showed similar rates of implicit bias on race and disability compared to the general public and other healthcare providers.[8]
A study of 6113 occupational therapy and physical therapy assistants testing implicit bias for people with disabilities. The authors found that the test group had a strong implicit bias, which shows that these therapists clinical interactions with people with disabilities will be influenced. They also concluded that these biases might be reproduced in clinical education, practice and policy.[9]
Clinicians need to be aware that the more the patient load, overcrowding and cognitive workload the more implicit bias creeps in.[10]
The Effect of Implicit Bias in Healthcare[edit | edit source]
It can influence the following:
- negative impact on quality of care
- assessment - the clinician might not adequately evaluate the needs of the patient[11]
- diagnosis[1]
- treatment decisions[1][12]
- treatment[12]
- level of care[1]
- frequency of eye contact[1]
- interpersonal interaction and connection with the patient[12]
- lead to discrimination[12]
- affects the way a therapist interprets and responds to patient feedback[11]
This results in health care disparities by giving different care to different people and influencing trust.[10]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC medical ethics. 2017 Dec;18(1):1-8.
- ↑ Bouley TM, Reinking AK. Implicit Bias: An Educator’s Guide to the Language of Microaggressions. Rowman & Littlefield; 2021 Nov 14.
- ↑ Implicit Bias. National Institutes of Health.
- ↑ 4.0 4.1 4.2 Cherry K. How does implicit bias influence behavior. Explanations and Impacts of Unconscious bias. Updated March 2023. Verywell Mind.
- ↑ Nikolopoulou, K. What Is Implicit Bias? | Definition & Examples. January 2023. Scribbr.
- ↑ White III AA, Chanoff D. Seeing patients: Unconscious bias in health care. Harvard University Press; 2011 Jan 15.
- ↑ Blair IV, Steiner JF, Havranek EP. Unconscious (implicit) bias and health disparities: where do we go from here?. The Permanente Journal. 2011;15(2):71.
- ↑ 8.0 8.1 8.2 8.3 Dunn B, Mcintosh J, Ray L, McCarty D. The Prevalence of Implicit Bias in Practicing Physical Therapists. Carolina Journal of Interdisciplinary Medicine. 2022 Dec 19;2(1).
- ↑ Feldner HA, VanPuymbrouck L, Friedman C. Explicit and implicit disability attitudes of occupational and physical therapy assistants. Disability and Health Journal. 2022 Jan 1;15(1):101217.
- ↑ 10.0 10.1 Vela MB, Erondu AI, Smith NA, Peek ME, Woodruff JN, Chin MH. Eliminating explicit and implicit biases in health care: evidence and research needs. Annual review of public health. 2022 Apr 5;43:477-501.
- ↑ 11.0 11.1 Banks TM. Implicit bias in occupational therapy practice. April 2023. OT Practice Magazine. Vol.28, Issue 4, pp. 10-14. American Occupational Therapy Association.
- ↑ 12.0 12.1 12.2 12.3 Setchel J. What is implicit bias & how it manifests in physiotherapy interactions with persons considered overweight or obese. May 2019. World Confederation of Physical Therapy Congress 2019 Geneva.
