Facing unconscious bias in health care: Understanding different experiences of patient and provider

Health care providers need to examine how their backgrounds and exposures influence what they think and how they feel.

Unconscious bias contributes to health disparities that can affect overall patient care and outcomes.

To address unconscious bias in patient care, the goal should not be to become “race blind,” but to acknowledge race, Jessica Isom, M.D., MPH, a clinical instructor and faculty leader in social justice and health equity with the Yale School of Medicine, New Haven, Connecticut, said during an episode of “MedChat,” a Norton Healthcare podcast. “MedChat” is produced by the Norton Healthcare Center for Continuing Medical, Provider & Nursing Education and is designed to provide evidence-based information with continuing medical education credit

“I’m going to acknowledge that I see it and acknowledge that I’m responding to it, but then also understand what it means, and it means that the person in front of me and I have had experiences relevant to my race that will shape how we interact with each other in this patient/provider relationship,” said Dr. Isom, who is also a psychiatrist at the Codman Square Health Center in Dorchester, Massachusetts.

In the “MedChat” episode, Dr. Isom spoke about conscious and unconscious bias with Monalisa M. Tailor, M.D., an internal medicine physician with Norton Community Medical Associates – Barret.

According to Dr. Isom, the Brief Implicit Association Test (BIAT) is one way of measuring unconscious bias. Introduced in 1998, the test measures the strengths of associations as a way of looking at attitudes, identities and stereotypes.

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The BIAT “can be so eye-opening,” Dr. Isom said. “I think the [B]IAT really helps open your mind to, ‘Hey, this is something I need to be more mindful of and I need to work on.’”

Data can be disaggregated to look at race and ethnicity.

When Dr. Isom looked at her own prescribing data, she realized that most of the patients who received prescriptions for stimulants were white, though her practice is 85% to 90% Black. She said she knew she needed to dig deeper.

“Is there something that people have done before me or not done?” Dr. Isom said she asked herself. “Or, is there something that I’m doing, or not doing, that is either producing that or reproducing it?”

Providers need to examine how their backgrounds and exposures influence what they think and how they feel, according to Dr. Isom.

Dr. Isom also recommends that providers go outside their bubbles and talk to patients about their experiences with racism and medicine and how they make the health care decisions they do: “How they make decisions about coming to see us, how they make decisions about whether they trust we have offered.”

As institutions work on organizational equity plans, Dr. Isom cited as a useful resource the Leading for Change Racial Equity and Justice Institute Practitioner Handbook produced by the Racial Equity and Justice Institute at Bridgewater State University in Massachusetts.

Medical organizations are working on their own blueprints, according to Dr. Isom, and she is working on anti-racism curriculum for the American Academy of Neurology.

Physicians have been trained to look at medicine through the lens of race, according to Dr. Isom.

“The legacy of medicine is to think about things in a raced way. We thought there were Black diseases and white diseases. This is something that’s been recycled over time that we don’t talk about, so we haven’t really addressed, which is why we’re really accepting of suggestions that there are raced diseases even now,” Dr. Isom said.

“I still remember how it felt to sit in the lecture hall and really only see representations of people like me and my family and my friends in really disparaging ways. So, you’d see the Latino person with diabetes and the Black person with syphilis, and there’s just not a lot of diversity in how those representations are shown to us,” she said.

MedChat is produced by Norton Healthcare's Center for Continuing Medical Education to provide evidence-based information with continuing medical education credit.


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