Conscious and Unconscious Biases in Health Care

Confronting Bias

ProviderIndividuals who admit to conscious biases are very clear about their beliefs, feelings, and attitudes toward others. Their associated behaviors are intentional and often openly demonstrative of such sentiments. The impetus to question or challenge one’s conscious biases may be impelled from an external source. However, it will require internal motivation to confront explicit bias and the willingness to take deliberate actions to change.

Where to Start?

In the case of health care professionals, a good place to begin is by giving thoughtful consideration to a series of probing questions. The basis for these questions was gleaned from the literature and indicates how bias affects quality of care and contributes to both health and health care disparities. Focusing on the real consequences of biases may serve as a motivating factor for health care professionals who are consciously aware of their biases to chart a course for change.

Probing Questions to Confront Conscious or Explicit Bias in Health Care

As you contemplate each question, consider factors such as age, race, ethnicity, gender, sexual orientation, gender identity or expression, English language proficiency, socioeconomic status, literacy, or body size.

  • Do my biases:
    • Impact the amount of time I spend with patients?
    • Influence how I communicate with patients and their families?
    • Hamper my capacity to feel and express empathy toward my patients?
    • Affect the types of treatment and medications I recommend?
    • Interfere with my capacity to interact positively with my patients and their families?
  • Do you ever perceive that you are less comfortable with patients who are of a different race than you?
  • Do you know whether (or believe that) your colleagues and other staff with whom you routinely work think that your attitudes and behaviors demonstrate bias? If so, are you open to discussing these issues with them to elicit their point of view?
  • Have patients or their families, directly or through satisfaction surveys, raised concern about your attitude or the way you communicate with them?

Answering yes to any of these questions clearly indicates that you could benefit from interventions to confront and mitigate the impact of explicit bias within your practice setting.

Moving to Interventions

The literature indicates that patients are attuned to and can observe the impact of implicit bias and the assumptions that result from it in their interactions with their physicians. Tucker et al1 interviewed low-income minority patients in primary care through focus groups and found that their definitions of culturally competent care (care that they experienced as sensitive to their needs) included the provider having good “people skills,” technical competence, individualized treatment, and effective communication. Cooper and Roter2 summarized studies showing that physicians deliver less information, less supportive talk, and less proficient clinical performance to Black and Hispanic patients and patients of lower socioeconomic class than they do to more advantaged patients. Johnson et al.3(p106) found that physicians were more verbally dominant and engaged in less patient-centered communication with African American patients than with White patients.

Make Good Use of the Neuroscience to Combat “Hard Wiring”

There is a strong body of evidence that describes the neurological mechanisms of unconscious or implicit bias. This literature also provides insight into how to use the neuroscience to create solutions to circumvent our hard wiring and combat unconscious bias. While there are many solutions to implicit bias, some are more practical and accessible than others. The following interventions were designed to address implicit racial bias, with an emphasis on positive or negative biases for both White and African American populations.

These following interventions are not limited to racial groups. They are applicable across groups defined by ethnicity, gender, age, limited language proficiency, socioeconomic status, and other demographic factors for which data are collected by your practice or health care organization. These solutions are suggested because they can easily be used and they can be included in physicians’ and other health care practitioners’ day-to-day practices.

Accepting that Racial Bias Exists

It is important that health care practitioners accept that they have implicit biases and that those biases may affect their day-to-day medical decision-making and interactions with their patients. Although it is not easy for anyone to admit that implicit biases may affect their decisions, it is particularly difficult for physicians and other health care practitioners. The overwhelming majority of health care practitioners probably hold the conscious belief that they are fair and that they help people every day. It is stressful for health care practitioners to consider and then accept that their implicit or unconscious biases may cause harm.