Overcoming the Subconscious

4 steps physicians can take to address implicit biases

Learn why implicit biases are a problem in medicine and how to address them.

Implicit biases can affect a physician’s medical judgment and be detrimental to patients.

It is important to acknowledge that everyone has implicit biases. They live in the subconscious of the mind and can affect our actions and thoughts involuntarily. Implicit biases can also impact our behavior toward different groups of people.

“The osteopathic profession must be committed to providing care to all populations,” Anthony Dekker, DO, says. “This is part of our profession from the very beginning.”

Dr. Dekker has published work in the Journal of the American Osteopathic Association about disparities in pain management and is the acting service line manager for East Units primary care services in the Northern Arizona Veterans Administration Healthcare System.

Addressing implicit biases is a conscious decision, and it can be difficult. Here are some steps physicians can take to confront this issue in medicine.

Step 1: Understand health disparities and bias in medicine

Research showing health disparities and health inequities in certain populations is ubiquitous. Studies consistently show that African-American patients are under-treated for pain. Hispanic patients have been found to have longer emergency department wait times for acute gastrointestinal illnesses. Even some medical students and residents think African-American patients feel less pain than white patients

Brookshield Laurent, DO, says she first teaches students about health disparities and health inequities such as these to help students understand the problem of implicit biases.

Dr. Laurent is the vice chair of clinical specialties at the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University. She co-directs a doctor-patient relationship course about how doctors build rapport with patients and build inter/intrapersonal communication skills.

“No one can deny that there are groups of people in the population of this country who have worse outcomes for every disease,” Dr. Laurent says.

Of course, many factors in addition to biases also influence patient outcomes, Dr. Laurent says.

Step 2: Take stock of your own implicit biases

Our subconscious is shaped throughout our lives by our demographics, experiences, geography, culture and ethnicity. One way to become self-aware about your implicit biases is to make a conscious effort to understand your gut reactions to certain patients or stressful situations.

“Our responsibility as medical educators is to be self-aware of our biases of other races,” Dr. Laurent says.

Project Implicit is an online resource that can help you identify your implicit biases. The online tests are designed to reveal thoughts and feelings outside of conscious awareness and control.

Step 3: Avoid categorizing specific groups of patients

When Dr. Dekker was the associate director of the Phoenix Indian Medical Center, he worked with some doctors who avoided prescribing any opioid medication in the emergency room regardless of a patient’s complaints.

Dr. Dekker says his colleagues’ beliefs were rooted in the fact that they felt Native Americans were a high-risk population for abuse issues.  The CDC has reported that Native Americans abuse prescription painkillers in higher numbers than Americans of other races.

“Physicians are doing a disservice to their patients when they start treating people based on their ethnicity rather than their medical disorder,” Dr. Dekker says.

Step 4: Address your implicit biases to practice better medicine

All physicians will benefit from addressing their implicit biases in their practice of medicine—most will become better physicians, Dr. Dekker says.

Understanding how implicit biases may be affecting your views of different groups of patients is an important first step to addressing them. Physicians can address their biases by paying attention to their gut reactions to different patients and pausing, when possible, to ask themselves if the reaction may be stemming from an implicit bias. If it is, the physician can consider how they might react to the same situation if it involved a different patient.

Editor’s note: Dr. Dekker’s opinions are his own and do not necessarily represent views of the U.S. Department of Veteran Affairs or the Northern Arizona Veterans Administration Healthcare System.

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