Clinicians’ Implicit Ethnic/Racial Bias and Perceptions of Care Among Black and Latino Patients

The Article in Brief

Clinicians' Implicit Ethnic/Racial Bias and Perceptions of Care Among Black and Latino Patients

Irene V. Blair , and colleagues

Background Bias can be explicit or implicit. Explicit bias is overt and freely expressed; implicit bias may not be consciously acknowledged and operates in more subtle ways. Clinicians are unlikely to directly express ethnic/racial bias yet may still deliver care that is influenced by unrecognized bias. In this study, patients evaluate the degree to which their clinicians are patient-centered during their interactions. Researchers then examine those evaluations in terms of patients' ethnicity/race and the clinicians' implicit and explicit ethnic or racial bias.

What This Study Found Clinicians with higher levels of implicit ethnic or racial bias are rated less favorably by black patients than are clinicians with lower levels of implicit bias. Surveys of nearly 3,000 patients found black patients rated clinicians who had greater implicit bias against blacks lower in patient-centered care than they did clinicians with little or no such implicit bias. Latino patients' ratings were not correlated to clinicians' implicit bias, though they tended to give clinicians lower ratings overall than did other groups.

Implications

• Clinicians' implicit bias may jeopardize their clinical relationships with black patients, which could have negative effects on other care processes, including adherence to medical advice.
• The authors conclude these findings support the Institute of Medicine's suggestion that clinician bias may contribute to health disparities. They note that implicit bias is malleable, and they encourage interventions that may help render bias less implicit and unconscious, thereby fostering real reflection, analysis, and change.