COMMENTARY

Keeping Your Potential Biases in Check Ensures Proper Patient Management

Christina M. Sorenson, OD

Disclosures

March 30, 2017

"Of all forms of inequity, injustice in healthcare is the most shocking and inhuman."
– Martin Luther King, Jr; National Convention of the Medical Committee for Human Rights; Chicago, 1966

Maybe you would be surprised by just how easy it is for our unconscious bias to affect our patient management and interactions. I was. So how come my implicit bias, despite my best efforts, still presents itself? And what can I do to ensure that my patient care is not affected by my bias?

Bias is defined as an attitude that is favorable or unfavorable toward people or things; stereotypes are a fixed impression of a group; and discrimination is the behavioral manifestation of bias and stereotyping.[1]

We all develop bias over our lifetime. In fact, bias has been instrumental in our survival. An easy example of beneficial bias that we still use every day is our ability to distinguish threats: Is that smile friendly or menacing? Classifications of people and things give order to our lives. We categorize people based on color, sex, economics, residence, education, and many other characteristics. This is the underpinning of bias, stereotypes, and discrimination. Once developed, bias and stereotypes are resistant to change; bias leaves a "mental residue."

So if implicit bias is sometimes helpful, why do we care about it?

Simply stated, differential management because of bias can lead to failures in healthcare. The Institute of Medicine's "Unequal Treatment" report found that, among other things, ethnic healthcare disparities do exist; bias was related to worse outcomes; and, more troubling, "unacceptable" healthcare provider contribution was present.[2]

van Ryn and colleagues[3] looked at the impact of racism on clinician cognition, behavior, and clinical decision-making. Their study produced some recommended behaviors for reducing provider bias. It turns out that just being aware of the potential for bias can reduce its incidence. Other techniques include empathy, positive attitude, and partnership building.

If you look at this list of attributes, it mirrors those of a clinician who is engaged and has a vested interest in the outcome of his or her care. It also parallels strategies to enhance patient compliance with management and treatment recommendations.

Avoiding bias can be complex or simple depending upon your perspective. I am going to take the simple route, because it seems to me that if we are truly interested in our patients and their care, implicit bias becomes harder and harder to manifest.

If you are interested in learning more about implicit bias or taking the Implicit Association Test, please visit Project Implicit.

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