Conscious and Unconscious Biases in Health Care

Pathway of Unconscious Bias

Overt expressions of prejudice and negative stereotypes have declined.12 However, even health care practitioners who enter the profession with positive intentions are not immune from the impact of unconscious or implicit bias. According to Burgess (2007), there is significant evidence of the following: (1) health care providers hold stereotypes based on patient race, class, sex, and other characteristics; (2) these stereotypes influence their interpretations of behaviors and symptoms and their clinical decisions; and (3) health care providers interact less effectively with minority than with White patients.14(p882)

Figure 1. Pathway of Unconscious Bias

Figure 1. Pathway of unconscious bias

In summary, Figure 1 reminds us that it is possible to categorize according to social group membership every interaction with another person, including encounters between health care practitioners and patients. Within that category are beliefs about the characteristics of that group, followed by an activation of feelings about that group. These feelings may influence one’s perceptions about and behavior toward the other person-manifestations of bias. Some feelings may be open and acknowledged (explicit and conscious), and other feelings may be outside of awareness (unconscious or implicit). We can all acknowledge that most health care practitioners have good intentions. However, when implicit bias is activated, behavior that is consonant with their expressed helpful beliefs about themselves as egalitarian persons (overt behavior) is accompanied by behavior that reflects the unconscious bias as well (inadvertent behavior). It is this latter aspect of behavior that contributes to the patients’ belief that they are in a prejudicial environment and therefore reduces their engagement in the treatment process.14

The good news is that when people have conscious access to their explicit biases, they are able to monitor and control them to mitigate their impact on their behavior.10(p770) Further, there are measures to help people identify their implicit biases such as the Implicit Association Test, which provides an opportunity to surface previously unknown biases.

Let’s learn more from a national expert on implicit bias.

Kimberly Papillon, Esq.,
Judicial Educator Consultant,
Regular Faculty at the National Judicial College