Is there evidence for unconscious bias in the delivery of medical care?

From the Guidelines

Yes, there is substantial evidence for unconscious bias in the delivery of medical care. Research consistently shows that healthcare providers may unknowingly treat patients differently based on race, gender, age, weight, socioeconomic status, and other characteristics. For example, studies have documented that Black patients often receive less pain medication than white patients with similar conditions, women's cardiac symptoms are more likely to be attributed to anxiety rather than heart disease, and obese patients may receive less thorough care due to weight stigma. These biases can manifest in various aspects of care including diagnosis, treatment recommendations, referral patterns, and provider-patient communication. The mechanisms behind unconscious bias involve automatic associations and stereotypes that healthcare providers may not be aware they hold. These biases can affect clinical decision-making even among well-intentioned providers who consciously reject prejudice.

Key Findings

• A study published in 2023 in the Blood Cancer Journal found that implicit racial bias is automatically activated in physicians and can lead to differential patient referral to clinical trials, limiting opportunities for racial and ethnic subpopulations 1.
• The study also found that African American patients perceived communication as less patient-centered and supportive among oncologists who had higher levels of implicit bias.
• Research indicates that health care providers' diagnostic decisions, as well as their feelings about patients, are influenced by patients' race or ethnicity, and that providers must be aware of their biases and stereotypes and attempt to understand how they influence actions and decisions during clinical encounters 1.

Recommendations

• Addressing unconscious bias requires multi-level interventions including provider education about bias recognition, implementation of standardized protocols to reduce subjective decision-making, diverse representation in healthcare leadership, and systematic monitoring of healthcare disparities to identify and address patterns of inequitable care.
• Healthcare organizations should reach out to surrounding community members and involve community representatives in planning and quality improvement initiatives.
• Quality improvement projects should incorporate race or ethnicity and primary language measures to reduce disparities in health care.

From the Research

Unconscious Bias in Medical Care

• There is evidence to suggest that unconscious bias plays a role in the delivery of medical care, contributing to health disparities and unequal treatment of patients 2, 3, 4, 5, 6.
• Studies have shown that healthcare providers may hold unconscious biases against marginalized groups, such as racial and ethnic minorities, which can affect patient-clinician communication, clinical decision making, and institutionalized practices 3, 4.
• Unconscious bias can result in disparate health outcomes, with some minority groups consistently receiving lower quality healthcare 2, 5.
• The causes of these disparities are multifactorial, but acknowledging and addressing unconscious bias is crucial to promoting just, equitable, and compassionate care to all patients 2, 4.

Factors Contributing to Unconscious Bias

• Cultural stereotypes and societal influences can contribute to the development of unconscious bias, even among healthcare providers who strive for equal treatment of all patients 4.
• High levels of cognitive load associated with clinical practice can also facilitate the activation of unconscious biases 5.
• Systemic issues, such as discriminatory practices and institutionalized racism, can perpetuate and sustain unconscious bias in healthcare settings 3, 6.

Mitigating Unconscious Bias

• Strategies to reduce unconscious bias include consciously taking patients' perspectives, intentionally focusing on individual patients' information apart from their social group, and increasing diversity among healthcare providers 4, 5.
• Counter-stereotypical stimuli and targeted experience with minority groups may also be effective in reducing unconscious bias 5.
• Addressing systemic issues and promoting equity through practical and impactful solutions is essential to mitigating the effects of unconscious bias in healthcare 3, 6.