Reducing Stigma Education Tools (ReSET) > 01. Recognizing One’s Own Biases.

01. Recognizing One’s Own Biases.

MODULE 2 | SECTION 1 OF 5

Recognizing One’s Own Biases

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Learning objective

Recognize one’s own biases, including implicit bias, and employ strategies to
mitigate bias.

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Recognize One’s Own Biases, Including Implicit Biases

Bias is the automatic activation of stereotypes related to race, gender, ethnicity, age and other characteristics, which has been demonstrated to influence judgment of and behavior toward individuals from stereotyped groups.1 It can be implicit (unconscious) or explicit (conscious and controlled). Additionally, stereotypes and biases may be more likely to be activated when cognitive resources are challenged by time limitations or stress.2

Research has shown that while explicit bias can evolve, implicit bias typically remains more stable over time without intervention.3 While those in the healthcare field take oaths to care for every human equally, they are not immune to bias. Therefore, providers must pay special attention to our own biases and work diligently to uncover those that are implicit so that they do not unwittingly cause harm to their patients.

Healthcare Providers Are Not Immune to Biases

  • Physicians reported less professional satisfaction treating patients with substance use disorders than patients with hypertension.4

  • Physicians reported lower regard for patients with substance use disorders than other medical conditions with behavioral components.5

  • Cognitive stressors in the emergency department such as overcrowding and patient load are associated with increased implicit bias in physicians.6

How Do Our Negative Biases Affect Patient Care?

Buprenorphine prescriptions for OUD treatment were received at considerably more visits by White patients than by patients of other races or ethnicities.7
Pediatricians who had a high degree of implicit pro-White bias were significantly less likely to prescribe post-surgical opioids (the standard of care) to Black patients.8
Hispanic patients were seven times less likely to receive opioids in the emergency room than non-Hispanic patients with similar injuries associated with pain. These findings were duplicated in Black patients.9
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Click here for a table of research relevant to implicit bias and clinical decision-making.

Although it can be uncomfortable to discover thoughts you didn’t believe you had, it is necessary that you take the time to do this work. Uncover your own implicit biases towards race, gender, and other demographics by using Project Implicit:

I’M READY

Click “I’m Ready” if you are committed to working on this. This activity should take no more than 5 minutes.

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Employ Strategies To Mitigate Bias

Strategies to address bias in physicians and learners are multifactorial and can be addressed on an individual and organizational level. Here, we will focus on efforts to address this on an individual level.

By completing Harvard’s Implicit Bias training above, you will become AWARE of which biases you have. Continue to maintain awareness of your implicit bias regularly.

Make a CHOICE to address the bias and CHANGE your behavior as needed.

Continually REEVALUATE where you are in your implicit biases and the decisions you make based on these.

The Following Methods Have Been Shown To
Decrease Implicit Bias Within The Clinical Setting:

 

Individuate

Individuating involves conscious effort to focus on specific information about an individual, making it more salient in decision-making than that person’s social category information (e.g., race or gender).1

Perspective-Taking

Perspective-taking is a conscious attempt to take and realize another person’s perspective which can reduce implicit bias in social interactions.10

Practice Cultural Humility

Cultural humility is a life-long commitment to self-evaluation and self-critique in an effort to address power imbalances and to advocate for others. Unlike cultural competency, cultural humility does not require or assume expertise in any social group, institution, or belief system.11

Establish Monitoring Procedures

Establish ongoing procedures for monitoring and assessing the effects of bias on health disparities.

“Understand and respect the tremendous power of unconscious bias… Do everything you can to become aware of and honestly face the biases that you personally might have, both those you know you have and those that take some digging to recognize… The most effective measure is our willingness to confront our deepest feelings about those who are different from us.” – (White 2011)

REFERENCES

  1. 1-Chapman EN, Kaatz A, Carnes M. Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities. J GEN INTERN MED. 2013;28(11):1504-1510. doi:10.1007/s11606-013-2441-1

 

  1. 2-Burgess DJ. Are Providers More Likely to Contribute to Healthcare Disparities Under High Levels of Cognitive Load? How Features of the Healthcare Setting May Lead to Biases in Medical Decision Making. Med Decis Making. 2010;30(2):246-257. doi:10.1177/0272989X09341751

 

  1. 3-Baron AS, Banaji MR. The Development of Implicit Attitudes. Evidence of Race Evaluations From Ages 6 and 10 and Adulthood. Psychological Science. 2006;17(1):53-58. doi:10.1111/j.1467-9280.2005.01664.x

 

  1. 4-Saitz R, Friedmann PD, Sullivan LM, et al. Professional Satisfaction Experienced When Caring for Substance-abusing Patients. Faculty and Resident Physician Perspectives. J Gen Intern Med. 2002;17(5):373-376. doi:10.1046/j.1525-1497.2002.10520.x

 

  1. 5-Mendiola CK, Galetto G, Fingerhood M. An Exploration of Emergency Physicians’ Attitudes Toward Patients With Substance Use Disorder: Journal of Addiction Medicine. 2018;12(2):132-135. doi:10.1097/ADM.0000000000000377

 

  1. 6-Johnson TJ, Hickey RW, Switzer GE, et al. The Impact of Cognitive Stressors in the Emergency Department on Physician Implicit Racial Bias. Gerson L, ed. Acad Emerg Med. 2016;23(3):297-305. doi:10.1111/acem.12901

 

  1. 7-Lagisetty PA, Ross R, Bohnert A, Clay M, Maust DT. Buprenorphine Treatment Divide by Race/Ethnicity and Payment. JAMA Psychiatry. 2019;76(9):979. doi:10.1001/jamapsychiatry.2019.0876

 

  1. 8-Sabin JA, Greenwald AG. The Influence of Implicit Bias on Treatment Recommendations for 4 Common Pediatric Conditions: Pain, Urinary Tract Infection, Attention Deficit Hyperactivity Disorder, and Asthma. Am J Public Health. 2012;102(5):988-995. doi:10.2105/AJPH.2011.300621

 

  1. 9-Todd KH, Hoffman JR. Ethnicity as a Risk Factor for Inadequate Emergency Department Analgesia. JAMA. 1993;269(12):1537-1539.

 

  1. 10Galinsky AD, Moskowitz GB. Perspective-taking: Decreasing stereotype expression, stereotype accessibility, and in-group favoritism. Journal of Personality and Social Psychology. 2000;78(4):708-724. doi:10.1037/0022-3514.78.4.708

 

  1. 11-Tervalon M, Murray-García J. Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. Journal of Health Care for the Poor and Underserved. 1998;9(2):117-125. doi:10.1353/hpu.2010.0233

 

  1. 12-White AA, Chanoff David. Seeing Patients : Unconscious Bias in Health Care. Cambridge, Mass. ; Harvard University Press; 2011. http://site.ebrary.com/id/10468997

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