How To Identify And Fight Implicit Bias in Medicine

Implicit bias refers to the attitudes, beliefs, and associations that influence a person’s actions in an unconscious way. Implicit bias is different from the explicit discrimination and “-isms” that are usually discussed. Explicit racism, sexism, and other forms of bigotry are relatively easy to identify and deride. They are driven by beliefs held in your conscious mind that a person can readily identify. Implicit bias, however, is more insidious. Your implicit biases operate beneath your conscious awareness, allowing them to fester and grow unchecked. Nevertheless, implicit biases can be just as harmful as the explicit forms of bigotry that are (mostly) openly rejected by society.

For example, a medical professional may unconsciously hold the belief that Black people are less sensitive to pain. While this is factually incorrect and goes against what they think consciously, that underlying belief can shape their medical decision making. Research has shown that minorities are less likely to receive adequate pain management for both acute and chronic pain. Despite the evidence that this occurs, it is hard to identify what influences physicians to prescribe less pain medication to people of certain backgrounds. Many believe that implicit biases play a part in this disparity because physician discretion influences which medicines are prescribed and to whom. If that is true, then tackling these implicit biases is important to improving patient care and achieving health equity. While I am definitely not an expert, I reached out to a few knowledgeable people and did a bit of research which led to the following ideas.

First, identify the problem

It can be really difficult to change beliefs that a person may not even be aware that they hold. Thus, on an individual level, the first step is increasing your awareness of your own biases. There are many online tests that actually can help to uncover your biases by forcing you to quickly make associations between adjectives and different groups of people. Harvard University’s Project Implicit is the most well-known example.

Beyond taking an online test, there are also more reflective methods to assess your biases. If you are on the wards, it can be helpful to pay attention to which patients you spend the most time with and enjoy being around. Alternatively, it can be helpful to notice which patients regularly cause negative emotions like apprehension or annoyance. Noting these down and reflecting on them may reveal that you prefer patients of particular races, socioeconomic classes, ages, or education levels.

For most people, such patterns will exist. We are primed by the media to make particular associations based on the images we are repeatedly shown. Additionally, when it comes to groups you do not have personal experience with, the media priming might be the only thing forming your subconscious bias. What’s important to know is that implicit biases can be influenced and controlled once they have been identified. Many medical schools exist in communities that are lower in socioeconomic status and that are more ethnically diverse than the medical students and professionals that practice on them. Especially in these contexts, we have an obligation to do the internal work on ourselves to make sure we are providing care with as little bias as possible.

Intentionally choose discomfort — for yourself and peers

After you notice that you are uncomfortable around a patient due to a bias, you can use that as an opportunity to challenge yourself. If time allows, get out of your comfort zone and spend a bit more time with those patients. Take a little extra time to think about the care you are providing them.

Besides yourself, pay attention to the people around you. Take note of which patients are not being treated as well by your institution. As students, we are often on the bottom of the totem pole so it can be difficult to speak up directly. However, you can always attempt to counteract the actions of others by being particularly kind or attentive to a patient who may be getting the short end of the stick. Of course, most hospitals will also have a mechanism for anonymously reporting an incident if you think it is warranted.

All in all, implicit bias is a complex, pervasive, and indolent phenomenon in our world and in the healthcare field. However, by learning, reflecting and challenging ourselves I believe students can begin to minimize its impacts on how we treat our patients.

Christina Amutah is a first year medical student at the Perelman School of Medicine at University of Pennsylvania. Christina graduated from Howard Uni...