Implicit Bias Beyond Law Enforcement

Lately, the concept of implicit bias has received a lot of media attention, particularly related to police shootings of black civilians. This concept has even become a point of controversy in the presidential election and in our public discourse. Since the subject of policing is so emotionally charged and contentious, it’s useful to explore implicit bias through another lens—that of health care—to clarify what this term really means and how it can show up in our daily lives.

A recent New York Times article described implicit bias as “the mind’s way of making uncontrolled and automatic associations between two concepts very quickly. In many forms, implicit bias is a healthy human adaptation — it’s among the mental tools that help you mindlessly navigate your commute each morning….But the same process can also take the form of unconsciously associating certain identities, like African-American, with undesirable attributes, like violence.”

In the fast-paced, stressful world of policing, where emotions are often high and decisions have to be made instantaneously, implicit biases that are contrary to people’s consciously held beliefs and values can be activated. This dynamic is not limited to law enforcement. Health care settings are similarly fast-paced and stressful, and doctors also have to make complex decisions that can have life or death consequences. As such, medicine is also a field where implicit bias can affect outcomes.

A number of studies have explored implicit bias in health care and its impact on health disparities. One study, for example, found that 67% of physicians recommended a knee replacement for a sample male patient, whereas only 33% of physicians recommended a knee replacement for a patient who was identical in all ways except gender. Presumably these physicians were not intentionally denying women knee replacements; rather, the study’s authors surmised that providers’ assumptions about women being too frail to withstand surgery, or being emotional and describing their pain to be more severe than it is, may have come into play.

Similarly, studies have found that African American and Hispanic patients brought into emergency rooms with long bone fractures were less likely to receive opioids and other analgesics than non-Hispanic Caucasian patients with the same condition. Again, this was likely not because of a conscious desire to deny patients pain management on the basis of race. The researchers in this study speculated that it may instead be due to the implicit bias that African American and Hispanic patients are more likely to be drug-seeking.

Dr. Thomas Inui, President of the Regenstrief Institute Inc., which studies vulnerable patient groups, has said of implicit bias: "Years of advanced education and egalitarian intentions are no protection against the effect of implicit attitudes…When do they surface? When we're involved with high-pressure, high-stakes decision-making, when there's a lot riding on our decisions but there isn't a lot of time to make them, that's when the implicit attitudes that are not scientific rise up and grab us.” Health care, like policing, is a field where high-pressure, high-stakes decision-making is the norm, and is therefore one in which implicit bias can be especially likely to show up.

The New York Times article points out that many people view implicit bias as the equivalent of racism, and assume that people who discuss its impact on police are really accusing police of racism. It is true that overt racism exists across our society and among people in all professions. But it is important to recognize that police—like doctors—can experience implicit bias in the course of their high-stakes professions. Understanding the reality of this phenomenon in society’s many spheres is an important first step for managing that bias so people can make decisions that are in line with their true beliefs and values.

By Joyce S. Dubensky, CEO, Tanenbaum

and Eliza Blanchard, Assistant Director, Workplace & Health Care Programs, Tanenbaum

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