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    Start From Within: How Implicit Bias Affects Your Patients

    This is one in a series of blogs, Start From Within, where we’re tackling some of the ‘softer’ parts of being a doctor, ones that you weren't tested on in medical school: healthcare inequity, the elements of professionalism as a doctor, what to do when patients have a bias, etc.

    Our mission is to make learning medicine easier. But we know it’s not just how you learn medicine—the way you apply your knowledge in clinical settings is immensely important, too. This blog series is meant to help you navigate the patient situations you face daily and improve your patient care. 

    The unintended impact on patient-provider interactions

    Implicit bias is a subconscious preference for or against a group of people. While you may not feel like you have any bias at all, it’s important to understand that every single person has biases, and we all bring them into our daily experiences and interactions.

    In fact, healthcare professionals exhibit the same levels of implicit bias as the wider population. Implicit bias may show up in different, subtle ways that you may not notice, but they can make a big difference in how your patient perceives you.

    You may unconsciously treat some patients differently by doing things like:

    • looking at the nurse or equipment more than them
    • spending less time touching them during an examination
    • standing further away from them
    • making assumptions about their ability to follow a treatment plan

    Even though implicit biases may be subtle, they can directly affect how your patients feel about the visit, your ability to have a healthy relationship with them, and how well they will stick to their healthcare plan.

    The unintended impact on patient health 

    Even though you may be unconscious of a bias, patients can have a strong reaction to how they feel they are treated during their visit, and it can have a substantial effect on what they do next. 

    In a 2017 survey of over 1,000 patients, of the 90% of patients who have visited a healthcare professional in the past five years, 11% said they had experienced some sort of bias from their clinicians. Of these patients:

    • 58% did not take any action in response to a biased remark 
    • 26% responded by changing their primary care physician 
    • 15% confronted their provider about the matter
    • 13% had plans to change their provider in the future
    • 11% posted a negative review online
    • 7% filed an official complaint with the hospital or practice

    Studies have also shown that when a patient feels they are being treated with bias by their doctor they are more likely to drop out of treatment, stop participating in screenings, delay filling prescriptions, and avoid healthcare settings altogether. 

    How to reduce implicit bias  

    This is a widespread issue that requires physicians everywhere to work towards a solution. So, what can you and your staff do to help ensure your patients are happy, healthy, and following their healthcare plan?

    First, start by taking Harvard’s Implicit-Association Test (IAT), which is designed to uncover unconscious biases. Once you are conscious of these implicit biases you are able to be aware of how they may affect you or your staff and how it might be perceived by a patient. Encourage everyone in your practice to try to avoid being influenced by these biases, and focus on what makes each patient an individual rather than a member of any group.

    Dr. Louis Penner studied how bias affects patient care and said:

    “If a doctor views the patient simply as a black woman, the possibility that the doctor’s implicit bias will be activated is much greater than if she’s seen as Mrs. Brown, a retired school teacher and mother of four children. So he’s not looking at a social category, he’s looking at an individual.” 

    To help paint the picture of the individual, take a minute or two during each visit to chat with patients about what’s going on in their lives, such as how their children are doing or what their weekend plans are. A brief conversation doesn’t add much time to the appointment, and it lays the groundwork for (or reinforces!) a positive relationship. Getting to know your patients as individuals will also help ensure you provide the best care possible for each of them, thus improving patient outcomes.

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